Objective:

To evaluate the potential of transanal tube (TA) placement in reducing the risk of anastomotic leakage (AL) in rectal cancer patients with adequate anastomotic perfusion confirmed by indocyanine green (ICG) fluorescence imaging, addressing a significant complication in surgical outcomes.

Key Findings:

• Anastomotic leakage remains a significant complication in rectal cancer surgery despite adequate perfusion confirmed by ICG.
• Transanal tube placement may help reduce AL by lowering intraluminal pressure, potentially improving postoperative recovery.
• Few studies have specifically examined the effectiveness of TA drainage in patients with confirmed adequate perfusion, highlighting a critical gap in the literature.

Interpretation:

The study highlights a potential adjunctive role for transanal tube placement in preventing AL, particularly in patients with confirmed adequate perfusion, which could improve surgical outcomes and patient quality of life.

Limitations:

• Retrospective design may introduce bias, limiting the generalizability of the findings.
• Limited data on specific leakage sites due to inconsistent recording in medical charts may affect the analysis of risk factors.
• The clinical utility of TA remains controversial and requires further investigation to establish its role in practice.

Conclusion:

Transanal tube placement may be beneficial in reducing anastomotic leakage in rectal cancer surgery with adequate perfusion, warranting further research to establish its clinical efficacy and potential integration into surgical protocols.