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Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients

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Abstract

Purpose

Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence.

Methods

This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors.

Results

Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls, p = 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5), p = 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1), p < 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4), p < 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24), p < 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls, p = 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9), p = 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0), p < 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876), p < 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9), p < 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05), p = 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59), p = 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91), p = 0.024].

Conclusion

Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic Akron General, Akron, OH, USA

    Abigail Christiansen

  2. Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Tara M. Connelly, Eddy P. Lincango, Michael Valente & Hermann Kessler

  3. Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA

    Tommaso Falcone, Cara King, Rosanne Kho & Miguel Luna Russo

  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Xue Jia

Authors
  1. Abigail Christiansen
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  2. Tara M. Connelly
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  3. Eddy P. Lincango
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  4. Tommaso Falcone
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  5. Cara King
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  6. Rosanne Kho
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  9. Michael Valente
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  10. Hermann Kessler
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Contributions

All authors are responsible for the conceptualization, funding acquisition, investigation, methodology, project administration, supervision, validation, writing—original draft, and writing—review and editing.

Corresponding author

Correspondence to Hermann Kessler.

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Ethics approval

This project was granted ethical approval from the Cleveland Clinic IRB board.

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Due to the anonymized nature of patient data, consent was waived.

Conflict of interest

The authors declare no competing interests.

Additional information

An abstract from this manuscript was presented at the 2023 Annual Scientific Meeting ASCRS in Seattle, WA June 4, 2023.

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The first two authors Abigail Christiansen and Tara M. Connelly are joint first authors.

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Christiansen, A., Connelly, T.M., Lincango, E.P. et al. Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients. Langenbecks Arch Surg 408, 385 (2023). https://doi.org/10.1007/s00423-023-03095-w

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  • DOI: https://doi.org/10.1007/s00423-023-03095-w

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