{"paper_id":"1bf10ead-2262-486f-a37d-23ddceb4b66b","body_text":"Abstract\nPurpose\nEndometriosis 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.\nMethods\nThis 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.\nResults\nOf 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].\nConclusion\nLimiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.\nSimilar content being viewed by others\nReferences\nBong JW, Yu CS, Lee JL et al (2019) Intestinal endometriosis: diagnostic ambiguities and surgical outcomes. World J Clin Cases 7(4):441–451\nAbrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C (2015) Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. 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J Minim Invasive Gynecol 21(6):1080–1085\nAuthor information\nAuthors and Affiliations\nContributions\nAll authors are responsible for the conceptualization, funding acquisition, investigation, methodology, project administration, supervision, validation, writing—original draft, and writing—review and editing.\nCorresponding author\nEthics declarations\nEthics approval\nThis project was granted ethical approval from the Cleveland Clinic IRB board.\nConsent to participate\nDue to the anonymized nature of patient data, consent was waived.\nConflict of interest\nThe authors declare no competing interests.\nAdditional information\nAn abstract from this manuscript was presented at the 2023 Annual Scientific Meeting ASCRS in Seattle, WA June 4, 2023.\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nThe first two authors Abigail Christiansen and Tara M. Connelly are joint first authors.\nRights and permissions\nSpringer 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.\nAbout this article\nCite this article\nChristiansen, A., Connelly, T.M., Lincango, E.P. et al. Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients. Langenbecks Arch Surg 408, 385 (2023). https://doi.org/10.1007/s00423-023-03095-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s00423-023-03095-w","source_license":"CC0","license_restricted":false}