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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 4/2016

01-04-2016 | Original Article

Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course

Authors: Carlos Frederico S. Marques, Caio Sergio R. Nahas, Ulysses Ribeiro Jr, Leonardo A. Bustamante, Rodrigo Ambar Pinto, Eduardo Kenzo Mory, Ivan Cecconello, Sergio Carlos Nahas

Published in: International Journal of Colorectal Disease | Issue 4/2016

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Abstract

Purpose

Transanal endoscopic microsurgery (TEM) is a safe and efficient minimally invasive treatment for rectal benign and early malignant neoplasia, but postoperative complications may be severe. We aimed to evaluate the risk factors related to the incidence, severity, and time course of postoperative complications of TEM.

Methods

This is a prospective study of postoperative complications in 53 patients (>18 years old) with benign or early rectal neoplasia who underwent TEM with curative intention or, for higher stages, palliation. Outcome measures included age, sex, American Society of Anesthesiologists score, neoadjuvant chemoradiotherapy, lesion height and size, pathologic margins, tumor histology, and suture type.

Results

Overall morbidity was 50 %. Temporary fecal incontinence was the most frequent complication (17.3 %). Complication rates of Clavien–Dindo grades I and II were 21.1 % and those of grades III and IV 3.8 %. Of patients with complications, more had lesions under the first rectal valve than over the first valve (61.54 % vs 38.46 %, p = 0.04). Patients submitted to chemoradiotherapy had a 24-fold greater chance of presenting grade II complications (p = 0.002). When the surgical defect was treated using the TEM device to perform the suture, the chance of having grade III complications was reduced 16-fold (p = 0.04). Fifty-three percent of complications occurred in the first 10 days and 95 % within 20 days.

Conclusions

Postoperative complications after transanal endoscopic microsurgery for the treatment of rectal neoplasia are frequent, acceptable, and usually controllable with pharmacologic treatment. Over time the nature of complications is continuous, centered on the first 20 days after surgery.
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Metadata
Title
Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course
Authors
Carlos Frederico S. Marques
Caio Sergio R. Nahas
Ulysses Ribeiro Jr
Leonardo A. Bustamante
Rodrigo Ambar Pinto
Eduardo Kenzo Mory
Ivan Cecconello
Sergio Carlos Nahas
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 4/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2527-4

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