Rates, trends, and short-term outcomes of colorectal resections for endometriosis: An ACS-NSQIP review

• Endometriosis is a rare but increasing indication for elective colorectal resection at NSQIP hospitals in the United States.
• Women undergoing colorectal resection for endometriosis are young and otherwise healthy.
• Post-operative complication rates and mortality are low in these women, even when rectal resections are required.
• Outcomes are improved with the use of minimally invasive surgery and this approach should be considered when feasible.

BackgroundThere is a paucity of literature regarding rates, trends, and outcomes of women with endometriosis undergoing elective colorectal resections in the United States. It was been suggested that endometriosis requiring colorectal resection is well suited for minimally invasive surgery.Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was searched from 2005 to 2014 for all elective colorectal resections performed for endometriosis. The proportion of resections was compared over time using a Cochran-Armitage test for trend. Univariate comparisons were made between patients with laparoscopic vs open resections.ResultsA total of 101,686 women underwent elective colorectal resections, of which 268 (0.26%) were performed for endometriosis. The proportion of endometriosis as the indication for resection increased over time (R2 = 0.77). Mean age was 42.9 ± 8.4 years with 72.8% non-Hispanic white. Median body mass index was 25.8 [interquartile range: 23.0, 31.5]. Overall, patients were healthy (82.8% American Society of Anesthesiologists classification I or II). Median length of stay was 4 [3, 6] days and 14.2% suffered any complication, with 9.0% having a minor complication and 7.1% having a major complication. There were no 30-day mortalities. The majority of cases (97.4%) were performed by a general/colorectal surgeon and the remainder by gynecologists. Forty-five (16.8%) underwent concurrent hysterectomy. Comparing open (n = 124) to laparoscopic approaches (n = 144) revealed no differences other than a longer length of stay (5 vs 4 days, p < 0.001) and operative time (180.5 vs 138.5 min, p = 0.02) in the open group.ConclusionsEndometriosis is a rare but increasing indication for elective colorectal resection at participating hospitals. The short-term outcomes after colorectal resection in this young and healthy population are acceptable and our data suggests that minimally invasive surgery should be considered in these patients.