Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients
Purpose Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence. Methods This is a retrospective review of consecutive cases of...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2023-09, Vol.408 (1), p.385-385, Article 385 |
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| creator | Christiansen, Abigail Connelly, Tara M. Lincango, Eddy P. Falcone, Tommaso King, Cara Kho, Rosanne Russo, Miguel Luna Jia, Xue Valente, Michael Kessler, Hermann |
| description | Purpose
Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence.
Methods
This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors.
Results
Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls,
p
= 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5),
p
= 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1),
p
< 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4),
p
< 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24),
p
< 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls,
p
= 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9),
p
= 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0),
p
< 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876),
p
< 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9),
p
< 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05),
p
= 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59),
p
= 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91),
p
= 0.024].
Conclusion
Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk. |
| doi_str_mv | 10.1007/s00423-023-03095-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2870989629</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2870989629</sourcerecordid><originalsourceid>FETCH-LOGICAL-c298t-dc2ae96fa557f6274912d0b22ae5ca153af1485970663aa728c9acb71cda2ea33</originalsourceid><addsrcrecordid>eNp9kE1PwzAMhiMEYmPwBzigHrkU8tE0DTc0jQ9pEhc4R16abpnaZiTtJv49KQXEiYNly378yn4RuiT4hmAsbgPGGWUpHoJhydPDEZqSjPGUZpwc_6kn6CyELcY4FzI7RRMmhGCU8imCRVu6xnTeumBDcrDdJtGudq3VCbRl4o3uoE5su3f13jSm7e6S0Pu11bELu513oDdfpOs7HZVCZBOS0WQHnY14OEcnFdTBXHznGXp7WLzOn9Lly-Pz_H6ZaiqLLi01BSPzCjgXVU5FJgkt8YrGLtdAOIOKZAWXAuc5AxC00BL0ShBdAjXA2Axdj7rxpvfehE41NmhT19Aa1wdFC4FlIXMqI0pHVHsXgjeV2nnbgP9QBKvBWjVaq_AQg7XqEJeuvvX7VWPK35UfLyPARiDEUbs2Xm1d79v483-ynzXdheg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2870989629</pqid></control><display><type>article</type><title>Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Christiansen, Abigail ; Connelly, Tara M. ; Lincango, Eddy P. ; Falcone, Tommaso ; King, Cara ; Kho, Rosanne ; Russo, Miguel Luna ; Jia, Xue ; Valente, Michael ; Kessler, Hermann</creator><creatorcontrib>Christiansen, Abigail ; Connelly, Tara M. ; Lincango, Eddy P. ; Falcone, Tommaso ; King, Cara ; Kho, Rosanne ; Russo, Miguel Luna ; Jia, Xue ; Valente, Michael ; Kessler, Hermann</creatorcontrib><description><![CDATA[Purpose
Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence.
Methods
This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors.
Results
Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls,
p
= 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5),
p
= 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1),
p
< 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4),
p
< 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24),
p
< 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls,
p
= 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9),
p
= 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0),
p
< 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876),
p
< 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9),
p
< 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05),
p
= 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59),
p
= 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91),
p
= 0.024].
Conclusion
Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.]]></description><identifier>ISSN: 1435-2451</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-023-03095-w</identifier><identifier>PMID: 37773225</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adult ; Cardiac Surgery ; Colectomy - adverse effects ; Colon - surgery ; Endometriosis - complications ; Endometriosis - diagnosis ; Endometriosis - surgery ; Female ; General Surgery ; Humans ; Laparoscopy - methods ; Medicine ; Medicine & Public Health ; Postoperative Complications - etiology ; Rectal Diseases - surgery ; Rectum - surgery ; Retrospective Studies ; Thoracic Surgery ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2023-09, Vol.408 (1), p.385-385, Article 385</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-dc2ae96fa557f6274912d0b22ae5ca153af1485970663aa728c9acb71cda2ea33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-023-03095-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-023-03095-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37773225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christiansen, Abigail</creatorcontrib><creatorcontrib>Connelly, Tara M.</creatorcontrib><creatorcontrib>Lincango, Eddy P.</creatorcontrib><creatorcontrib>Falcone, Tommaso</creatorcontrib><creatorcontrib>King, Cara</creatorcontrib><creatorcontrib>Kho, Rosanne</creatorcontrib><creatorcontrib>Russo, Miguel Luna</creatorcontrib><creatorcontrib>Jia, Xue</creatorcontrib><creatorcontrib>Valente, Michael</creatorcontrib><creatorcontrib>Kessler, Hermann</creatorcontrib><title>Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description><![CDATA[Purpose
Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence.
Methods
This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors.
Results
Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls,
p
= 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5),
p
= 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1),
p
< 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4),
p
< 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24),
p
< 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls,
p
= 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9),
p
= 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0),
p
< 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876),
p
< 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9),
p
< 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05),
p
= 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59),
p
= 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91),
p
= 0.024].
Conclusion
Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.]]></description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Cardiac Surgery</subject><subject>Colectomy - adverse effects</subject><subject>Colon - surgery</subject><subject>Endometriosis - complications</subject><subject>Endometriosis - diagnosis</subject><subject>Endometriosis - surgery</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Postoperative Complications - etiology</subject><subject>Rectal Diseases - surgery</subject><subject>Rectum - surgery</subject><subject>Retrospective Studies</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>1435-2451</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PwzAMhiMEYmPwBzigHrkU8tE0DTc0jQ9pEhc4R16abpnaZiTtJv49KQXEiYNly378yn4RuiT4hmAsbgPGGWUpHoJhydPDEZqSjPGUZpwc_6kn6CyELcY4FzI7RRMmhGCU8imCRVu6xnTeumBDcrDdJtGudq3VCbRl4o3uoE5su3f13jSm7e6S0Pu11bELu513oDdfpOs7HZVCZBOS0WQHnY14OEcnFdTBXHznGXp7WLzOn9Lly-Pz_H6ZaiqLLi01BSPzCjgXVU5FJgkt8YrGLtdAOIOKZAWXAuc5AxC00BL0ShBdAjXA2Axdj7rxpvfehE41NmhT19Aa1wdFC4FlIXMqI0pHVHsXgjeV2nnbgP9QBKvBWjVaq_AQg7XqEJeuvvX7VWPK35UfLyPARiDEUbs2Xm1d79v483-ynzXdheg</recordid><startdate>20230929</startdate><enddate>20230929</enddate><creator>Christiansen, Abigail</creator><creator>Connelly, Tara M.</creator><creator>Lincango, Eddy P.</creator><creator>Falcone, Tommaso</creator><creator>King, Cara</creator><creator>Kho, Rosanne</creator><creator>Russo, Miguel Luna</creator><creator>Jia, Xue</creator><creator>Valente, Michael</creator><creator>Kessler, Hermann</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230929</creationdate><title>Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients</title><author>Christiansen, Abigail ; Connelly, Tara M. ; Lincango, Eddy P. ; Falcone, Tommaso ; King, Cara ; Kho, Rosanne ; Russo, Miguel Luna ; Jia, Xue ; Valente, Michael ; Kessler, Hermann</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-dc2ae96fa557f6274912d0b22ae5ca153af1485970663aa728c9acb71cda2ea33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Cardiac Surgery</topic><topic>Colectomy - adverse effects</topic><topic>Colon - surgery</topic><topic>Endometriosis - complications</topic><topic>Endometriosis - diagnosis</topic><topic>Endometriosis - surgery</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Postoperative Complications - etiology</topic><topic>Rectal Diseases - surgery</topic><topic>Rectum - surgery</topic><topic>Retrospective Studies</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christiansen, Abigail</creatorcontrib><creatorcontrib>Connelly, Tara M.</creatorcontrib><creatorcontrib>Lincango, Eddy P.</creatorcontrib><creatorcontrib>Falcone, Tommaso</creatorcontrib><creatorcontrib>King, Cara</creatorcontrib><creatorcontrib>Kho, Rosanne</creatorcontrib><creatorcontrib>Russo, Miguel Luna</creatorcontrib><creatorcontrib>Jia, Xue</creatorcontrib><creatorcontrib>Valente, Michael</creatorcontrib><creatorcontrib>Kessler, Hermann</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christiansen, Abigail</au><au>Connelly, Tara M.</au><au>Lincango, Eddy P.</au><au>Falcone, Tommaso</au><au>King, Cara</au><au>Kho, Rosanne</au><au>Russo, Miguel Luna</au><au>Jia, Xue</au><au>Valente, Michael</au><au>Kessler, Hermann</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2023-09-29</date><risdate>2023</risdate><volume>408</volume><issue>1</issue><spage>385</spage><epage>385</epage><pages>385-385</pages><artnum>385</artnum><issn>1435-2451</issn><eissn>1435-2451</eissn><abstract><![CDATA[Purpose
Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence.
Methods
This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors.
Results
Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls,
p
= 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5),
p
= 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1),
p
< 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4),
p
< 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24),
p
< 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls,
p
= 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9),
p
= 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0),
p
< 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876),
p
< 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9),
p
< 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05),
p
= 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59),
p
= 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91),
p
= 0.024].
Conclusion
Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.]]></abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37773225</pmid><doi>10.1007/s00423-023-03095-w</doi><tpages>1</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Langenbeck's archives of surgery, 2023-09, Vol.408 (1), p.385-385, Article 385 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Adult Cardiac Surgery Colectomy - adverse effects Colon - surgery Endometriosis - complications Endometriosis - diagnosis Endometriosis - surgery Female General Surgery Humans Laparoscopy - methods Medicine Medicine & Public Health Postoperative Complications - etiology Rectal Diseases - surgery Rectum - surgery Retrospective Studies Thoracic Surgery Traumatic Surgery Treatment Outcome Vascular Surgery |
| title | Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients |
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