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

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Peritoneal perforation (PP) is a known complication of transanal endoscopic microsurgery (TEM).
• Long-term oncologic consequences of PP after TEM have not been well-documented.
• Understanding PP's impact is crucial for refining TEM procedures.

Purpose of the Study:

• To evaluate the influence of peritoneal perforation (PP) on short- and long-term outcomes in patients undergoing transanal endoscopic microsurgery (TEM).
• To assess the oncologic safety of TEM in cases complicated by PP.

Main Methods:

• Prospective database analysis of patients undergoing TEM for rectal neoplasms.
• Comparison of outcomes between patients with and without PP.
• Multivariate analysis to identify predictors of PP.

Main Results:

• Peritoneal perforation (PP) occurred in 5.8% of 481 TEM procedures.
• PP was associated with longer operating time and hospital stay but similar morbidity rates.
• Tumor distance from the anal verge was the only independent predictor of PP.
• No liver or peritoneal metastases were detected during follow-up in rectal cancer patients.

Conclusions:

• Peritoneal perforation (PP) does not negatively affect short-term or oncologic outcomes after TEM for upper rectal neoplasms.
• TEM is a viable option for rectal lesions involving the intraperitoneal rectum.
• These findings support the development of transrectal NOTES techniques.