Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Rectal Neoplasms

Background:

• Rectal tumor excision often involves full-thickness wall excision, with defect closure typically recommended.
• Recent studies present conflicting data, leading to a trend of leaving post-excision rectal defects unsutured.

Purpose of the Study:

• To compare postoperative outcomes and recurrence rates between sutured and unsutured rectal defects after transanal surgery for rectal neoplasm.
• To evaluate the adequacy of leaving rectal defects open versus suturing them closed.

Main Methods:

• Retrospective review of a prospectively maintained database of adult patients undergoing transanal surgery for rectal neoplasm (1997-2019).
• Patients were categorized into two groups: Group A (sutured defect) and Group B (unsutured defect).
• Primary outcomes assessed included early and late morbidity and recurrence rates.

Main Results:

• Analysis included 404 patients (143 in Group A, 261 in Group B).
• No significant differences were found in tumor size, distance from the anal verge, or operation time between groups.
• The overall incidence of complications was significantly higher in Group B (unsutured defects), nearly doubling the rate observed in Group A (sutured defects).
• Seven cases of rectal stricture were reported, all occurring in Group B patients, with a mean follow-up of 58 months.

Conclusions:

• Suturing rectal defects after local excision, when feasible, appears to offer advantages in terms of reduced postoperative complications.
• Leaving rectal defects unsutured is associated with a higher morbidity rate, including an increased risk of rectal stricture.
• The findings suggest that defect closure should be considered the preferred management strategy when technically possible.