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Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Transanal endoscopic microsurgery (TEM) is a safe and efficient minimally invasive treatment for rectal benign and early malignant neoplasia, but postoperative complications may be severe. We aimed to evaluate the risk factors related to the incidence, severity, and time course of postoperative complications of TEM.

Methods

This is a prospective study of postoperative complications in 53 patients (>18 years old) with benign or early rectal neoplasia who underwent TEM with curative intention or, for higher stages, palliation. Outcome measures included age, sex, American Society of Anesthesiologists score, neoadjuvant chemoradiotherapy, lesion height and size, pathologic margins, tumor histology, and suture type.

Results

Overall morbidity was 50 %. Temporary fecal incontinence was the most frequent complication (17.3 %). Complication rates of Clavien–Dindo grades I and II were 21.1 % and those of grades III and IV 3.8 %. Of patients with complications, more had lesions under the first rectal valve than over the first valve (61.54 % vs 38.46 %, p = 0.04). Patients submitted to chemoradiotherapy had a 24-fold greater chance of presenting grade II complications (p = 0.002). When the surgical defect was treated using the TEM device to perform the suture, the chance of having grade III complications was reduced 16-fold (p = 0.04). Fifty-three percent of complications occurred in the first 10 days and 95 % within 20 days.

Conclusions

Postoperative complications after transanal endoscopic microsurgery for the treatment of rectal neoplasia are frequent, acceptable, and usually controllable with pharmacologic treatment. Over time the nature of complications is continuous, centered on the first 20 days after surgery.

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Acknowledgments

We wish to acknowledge the statistical work by Marcio Augusto Diniz, Laboratory of Epidemiology and Statistics, USP School of Medicine; and supervision by Professor Julio Cesar Rodrigues Pereira, School of Public Health, USP.

Author contributions

Carlos Frederico S. Marques: Surgery of patients, conception of design of study, writing of manuscript

Caio Sergio R. Nahas: Surgery of patients, data acquisition, critical revision of manuscript

Ulysses Ribeiro Jr: Preoperative patient selection, postoperative patient follow-up, writing and critical revision of manuscript

Leonardo A. Bustamante: Drafting and writing of manuscript, tables and revision of manuscript

Rodrigo Ambar Pinto: Revision of manuscript, endorectal ultrasonography, postoperative patient follow-up

Eduardo Kenzo Mory: Postoperative patient follow-up, data acquisition, revision of manuscript, critical revision of statistics

Ivan Cecconello: Discussion of indications, conception of design of study, revision of manuscript, critical revision of statistics

Sergio Carlos Nahas: Surgery of patients, conception of design of study, writing and revision of manuscript

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Authors and Affiliations

  1. Digestive Surgery, Gastroenterology Department, Hospital das Clinicas/Cancer Institute University of São Paulo Medical School, Rua Dona Adma Jafet, 74, cj172–174, Bela Vista, São Paulo, SP, 01308-050, Brazil

    Carlos Frederico S. Marques, Caio Sergio R. Nahas, Ulysses Ribeiro Jr, Leonardo A. Bustamante, Rodrigo Ambar Pinto, Eduardo Kenzo Mory, Ivan Cecconello & Sergio Carlos Nahas

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  1. Carlos Frederico S. Marques
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Correspondence to Carlos Frederico S. Marques.

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Marques, C.F.S., Nahas, C.S.R., Ribeiro, U. et al. Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course. Int J Colorectal Dis 31, 833–841 (2016). https://doi.org/10.1007/s00384-016-2527-4

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