Complications after transanal endoscopic microsurgical resection correlate with location of rectal neoplasms.
OBJECTIVE
Transanal endoscopic microsurgery (TEM) is a technique that has found its place in routine practice due to its minimal invasive character and associated low morbidity. The purpose of this study was to assess the influence of anatomical variables of rectal neoplasms as well as surgeon experience on postoperative complications in patients undergoing TEM at a tertiary care center.


METHODS
Data from 288 patients undergoing TEM over a 16 year period were entered in a prospective data base. Anatomical data of rectal neoplasms, operative data, and early postoperative outcome were analyzed retrospectively.


RESULTS
Overall surgical complications [OR 7.0 (1.5-45,5); p < 0.01] and bleeding [OR 222 (82 - 14316); p < 0.01] correlated with the localization of the neoplasm on the lateral wall of the rectum. Furthermore there was a trend for more surgical overall complications as well as bleeding in neoplasms with a diameter of >2 cm and neoplasms located >8 cm from the anal verge. Complications did not correlate with the number of TEM procedures performed.


CONCLUSIONS
TEM resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding. The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery.
Kreissler-Haag
D
D
Department of General, Visceral, Vascular, and Pediatric Surgery, University of the Saarland, 66421, Homburg/Saar, Germany.
Schuld
J
J
Lindemann
W
W
König
J
J
Hildebrandt
U
U
Schilling
M
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D053159:Dysuria / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011336:Probability; D011351:Proctoscopy / Q000009:adverse effects* / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate