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Perforation in the peritoneal cavity during transanal endoscopic microsurgery for rectal tumors: a real surgical complication with a challenging prognosis?

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Abstract

Background

Perforation in the peritoneal cavity during transanal endoscopic microsurgery represents a major challenge. It is usually treated by primary suture, though some authors propose laparoscopic repair with or without ostomy. It is unclear whether perforation increases the risk of tumor dissemination.

Aim

The purpose of the study is to assess the safety of primary suture of peritoneal perforation and the long-term risk of dissemination, also, to determine risk factors for perforation and to propose a predictive model for lesions with risk of perforation.

Method

This is an observational study with prospective data collection at Parc Taulí University Hospital, Sabadell, of patients undergoing transanal surgery with perforation into the peritoneal cavity from June 2004 to September 2017. The main variable is postoperative morbidity and mortality. The long-term follow-up of local recurrence and peritoneal tumor dissemination is described, and a quantitative predictive model for peritoneal cavity perforation is proposed.

Results

Forty-five patients out of 686 (6.6%) presented perforation into the peritoneal cavity. Ten patients (22.2%) in the perforation group had morbidity, a rate similar to the non-perforated group. There was no peritoneal dissemination in patients with adenoma or with carcinoma treated with curative intent. In the quantitative predictive model, risk factors for perforation were proximal edge of tumor > 14 cm from anal verge (6 points), size ≥ 6 cm (2), age ≥ 85 years (4), anterior quadrant (3) , and sex (2). Total scores of ≥ 6 points predicted perforation.

Conclusions

Primary suture after peritoneal cavity perforation during transanal surgery is safe and does not increase the risk of recurrence or peritoneal dissemination. Our predictive model provides guidance regarding the risk of perforation and the need to suture the defect after transanal surgery resection.

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Acknowledgements

We thank the rest of the members of the Coloproctology Unit for applying the study protocol. We thank Cristina Gomez Vigo for correcting the manuscript and Michael Maudsley for helping with English.

Funding

No financial support was provided for the study.

Author information

Authors and Affiliations

  1. Coloproctology Unit, General and Digestive Surgery Department,, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain

    Xavier Serra-Aracil, Anna Pallisera-Lloveras, Laura Mora-Lopez, Pere Rebasa, Sheila Serra-Pla & Salvador Navarro

Authors
  1. Xavier Serra-Aracil
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  2. Anna Pallisera-Lloveras
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  3. Laura Mora-Lopez
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  5. Sheila Serra-Pla
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  6. Salvador Navarro
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Contributions

All named authors have made the following contributions to the manuscript: (1) substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; (2) participation in drafting the article or revising it critically for important intellectual content; and (3) approval of the final version to be submitted and any revised version.

Corresponding author

Correspondence to Anna Pallisera-Lloveras.

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Conflict of interest

Xavier Serra-Aracil, Anna Pallisera-Lloveras, Laura Mora-Lopez, Pere Rebasa, Sheila Serra-Pla, and Salvador Navarro have no conflicts of interest or financial ties to disclose.

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Serra-Aracil, X., Pallisera-Lloveras, A., Mora-Lopez, L. et al. Perforation in the peritoneal cavity during transanal endoscopic microsurgery for rectal tumors: a real surgical complication with a challenging prognosis?. Surg Endosc 33, 1870–1879 (2019). https://doi.org/10.1007/s00464-018-6466-8

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  • DOI: https://doi.org/10.1007/s00464-018-6466-8

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