Clinical Practice Guidelines - National Health and Medical Research ...

does not permit its earlier recognition. 78,79,81 A recent Cochrane review also confirms that there is no
difference of outcome measures after prophylactic drainage of anastomoses after elective colorectal
surgery or no drainage, revealing the lack of scientific evidence for the use of drainage. 82
Despite this, the use of pelvic drainage after rectal resection is widely practised, and there is no
evidence to indicate that it has a detrimental effect on anastomotic healing. 81
Guideline — Drainage
Routine drainage should only be considered for
rectal cancers
Rectal washout
Level of
evidence
Practice
recommendation
II Equivocal
Refs
76,77,
79–81
Exfoliated malignant cells have been demonstrated in the bowel lumen in patients with primary
Colorectal Cancer. 83–90 The viability of these cells has been confirmed, and reduction in their viability
by application of a variety of chemical constituents has been established. 81–78
Experimentally-induced anastomotic implantation of luminal cells has been demonstrated in an
animal model. 91 Cases of implantation metastases in anal wounds from occult proximal tumours have
been reported. 91 Therefore, it seems logical that elimination of viable exfoliated malignant cells from
the vicinity of the anastomosis may prevent implantation metastases, and so reduce the risk of
locoregional tumour recurrence. This has not been investigated by a clinical trial to date.
However, irrigation of the rectal stump with normal saline immediately before anastomosis for rectal
and sigmoid tumours has been shown to eliminate malignant cells from the perianastomosis zone. 90
Irrigation of the rectal stump before anastomosis should be considered in all patients undergoing
restorative resection for rectal cancer.
Elective surgery for rectal cancer
143