Pelvic drain after colorectal anastomosis: useful or useless

Strategies for rectal cancer surgery have been evolved and total mesorectal excision (TME) now becomes a standard treatment for middle to low rectal cancer (1). In suitable cases, surgeon will perform bowel restoration after rectal removal with TME because patient with sphincter-saving operation had a better quality of life than those with abdominoperineal excision (2). However, TME has been shown to be associated with high anastomotic leakage, particularly in those receiving neoadjuvant chemoradiation (3). According to the definition of anastomotic leakage proposed by the International Study Group of Rectal Cancer in 2010, anastomotic leakage is defined as a defect of the intestinal wall at the anastomotic site—including suture and staple lines of neorectal reservoirs which leads to a connection between intraluminal compartment and extraluminal compartment (4).