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  • Title: Complications of transanal endoscopic microsurgery are rare and minor: a single institution's analysis and comparison to existing data.
    Author: Kumar AS, Coralic J, Kelleher DC, Sidani S, Kolli K, Smith LE.
    Journal: Dis Colon Rectum; 2013 Mar; 56(3):295-300. PubMed ID: 23392142.
    Abstract:
    BACKGROUND: Transanal endoscopic microsurgery, a minimally invasive procedure for treatment of early-stage rectal cancer, carcinoid tumors, and adenomas, is shown to be a safe procedure with very low perioperative morbidity. OBJECTIVE: We aimed to compare the outcomes of transanal endoscopic microsurgery at a large volume tertiary care center with the existing literature. DESIGN: We retrospectively reviewed a prospectively collected database of 325 transanal endoscopic microsurgery procedures and looked for risk factors associated with complications. Indications for transanal endoscopic microsurgery included rectal adenocarcinomas, adenomas, and carcinoids. SETTING: Procedures were performed by a single surgeon at a large-volume tertiary care center. PATIENTS: Patients were enrolled over a 20-year period, and data were collected on demographics, perioperative details, tumor characteristics, and complications. INTERVENTIONS: Transanal endoscopic microsurgery was performed on all 325 patients. MAIN OUTCOME MEASURES: Main outcome measures were urinary retention, late bleeding requiring intervention, dehiscence, peritoneal cavity entry, conversion to abdominal approach, fecal soiling, and rectovaginal fistula. RESULTS: Intraoperative bleeding was associated with larger tumor size, whereas postoperative bleeding requiring intervention was not associated with any factors studied. Peritoneal cavity entry and urinary retention were more likely if the tumor was in either the anterior or lateral position in the rectum. The peritoneal cavity was entered in 9 patients, and conversion to abdominal approach occurred in 1 patient. Intraoperative bleeding, by surgeon's choice, and urinary retention, by patient's choice, were associated with a greater likelihood of admission to the inpatient ward. Fecal soiling was not reported by patients and not recorded. LIMITATIONS: This study was limited because it was a retrospective analysis CONCLUSIONS: Transanal endoscopic microsurgery is an extremely safe procedure, offering very low perioperative morbidity. The overall morbidity found in our study was 10.5%, on par with published data for large series of 21%, 7.7%, and 14.9%. In contrast, complications from radical resection are reported at 18% to 55%.
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