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Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery?

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Abstract

Background

Peritoneal perforation (PP) is frequently reported as a complication of transanal endoscopic microsurgery (TEM). Nevertheless, these concerns have only rarely been addressed in the literature, with no mention of the long-term oncologic consequences of PP.

Methods

A prospective database was analyzed with the intent to evaluate the influence of PP on the short- and long-term outcomes for patients undergoing TEM.

Results

Peritoneal perforation occurred in 28 (5.8 %) of 481 patients who underwent TEM for a rectal neoplasm. The conversion rate to abdominal surgery was 10.7 % (3/28). All the conversions occurred during the first 100 TEM procedures (3/100 vs 0/381; p = 0.007). The postoperative morbidity rate was 3.6 % (1/28), and the 30-day mortality was nil. Compared with the group of patients who had no peritoneal perforation, the PP group showed a significantly longer operating time (120 vs 60 min; p < 0.001) and a significantly longer hospital stay (6 vs 4 days; p = 0.003). Nevertheless, the global morbidity rate and the type of complications according to Dindo’s classification were similar. In the multivariate analysis, the only independent predictor of PP was tumor distance from the anal verge (p = 0.010). During a median follow-up period of 48 months (range, 12–150 months), no liver or peritoneal metastases were detected in 13 patients with rectal cancer.

Conclusions

Peritoneal perforation does not seem to affect short-term or oncologic outcomes for patients submitted to TEM with full-thickness resection for upper rectum neoplasms. The use of TEM to resect rectal lesions involving the intraperitoneal rectum may therefore represent an intermediate step toward the development of transrectal natural orifice translumenal endoscopic surgery (NOTES) techniques.

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Disclosures

The authors Mario Morino, Marco Ettore Allaix, Federico Famiglietti, Mario Caldart, and Alberto Arezzo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Corso A. M. Dogliotti 14, 10126, Torino, Italy

    Mario Morino, Marco Ettore Allaix, Federico Famiglietti, Mario Caldart & Alberto Arezzo

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  1. Mario Morino
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  2. Marco Ettore Allaix
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Correspondence to Marco Ettore Allaix.

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Morino, M., Allaix, M.E., Famiglietti, F. et al. Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery?. Surg Endosc 27, 181–188 (2013). https://doi.org/10.1007/s00464-012-2418-x

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