Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery?
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.
Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Torino, Italy. mario.morino@unito.it
Mario
M
Morino
Marco Ettore
ME
Allaix
Federico
F
Famiglietti
Mario
M
Caldart
Alberto
A
Arezzo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D061646:Operative Time; D010537:Peritoneum / Q000293:injuries*; D011183:Postoperative Complications / Q000209:etiology; D011351:Proctoscopy / Q000009:adverse effects*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult