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Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise



This study was designed to investigate short-term and long-term consequences from perforation to the peritoneal cavity during transanal endoscopic microsurgery (TEM) for rectal cancer, with special emphasis on local recurrence and complications.


Data from TEM procedures with peritoneal perforations were collected from six prospective databases. Patient, procedure, and follow-up data were extracted. Participating centers were the United Kingdom TEM database, the German TEM database from Mainz, the National Danish TEM database, and databases from the three major Norwegian TEM centers. A total of 888 TEM procedures were registered, and 22 perforations were identified.


Median age was 82 years. Tumor stages were 14 pT1, 4 pT2, 3 pT3, and 1 pTx. The mean tumor size was 4.1 cm. Radical resection was achieved in 17 patients. All perforations were handled endoscopically. There were no severe complications and no deaths related to the procedure. The mean time of observation was 37 (median 36; range 3–164) months. Local recurrence occurred in two patients, three patients died from the cancer (distant metastasis), and six died from other causes.


Breaching the peritoneum during TEM is not associated with major short-term complications or long-term oncological consequences provided that primary endoscopic repair is undertaken.

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The following TEM surgeons are thanked for their contribution to the databases:

The UK TEM users group: Arthur Allan, Good Hope Hospital; Simon Ambrose, St James’, Leeds; N. Armitage, Queens, Nottingham; Neil Borley, Cheltenham; Paul Hainsworth, Freeman Hospital, Newcastle; David Hay, Glan Clwyd Hospital; Mike Hershman, Royal Liverpool; James Hill, Manchester Royal Infirmary; Kartheuser, Saint-Luc, Brussels; Ruth McKee, Glasgow Royal Infirmary; John Monson, Castle Hill Hospital, Hull; Neil Mortensen, John Radcliffe Hospital, Oxford; Andrew Radcliffe, Llandough Hospital, Penarth; John Scholefield, Queens Medical Centre, Nottingham; Adam Scott, Glenfield General Hospital, Leicester; Andrew Shorthouse, Royal Hallamshire, Sheffield; Jay Simson, St Richard’s, Chichester; Bill Stebbings, Norfolk and Norwich Hospital; Bob Steele, Ninewells, Dundee; Arthur Sun-Myint, Clatterbridge; Michael Thomas, Bristol Royal Infirmary; Nigel Williams, Walsgrave.

The Mainz TEM database: Theodor Junginger, Gerhard Buess, Achim Heinz, Michael Korenkov, Jens Burghard.

The Danish TEM group: Peter Hesselfeldt, Hvidovre University Hospital; Peer Wille-Jørgensen, Bispebjerg University Hospital; Henrik Elbrønd, Ålborg University Hospital; Peter Møller, Bispebjerg University Hospital.

The Norwegian TEM surgeons: Arild Nesbakken, Aker University Hospial; Birger Endreseth, St Olav University Hospital.

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Correspondence to Gunnar Baatrup.

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Baatrup, G., Borschitz, T., Cunningham, C. et al. Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Surg Endosc 23, 2680 (2009).

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  • Bowel
  • Colorectal
  • Cancer
  • Surgical
  • Technical