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Full thickness transanal re-excision following endoscopic removal of malignant rectal polyps

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Abstract

Purpose

Segmental resection is recommended for malignant polyps of the colon that are removed endoscopically with questionable margins. However, when such a lesion is present in the rectum, radical resection may involve a higher risk procedure such as low anterior resection or abdominoperineal resection. We report our long-term results in patients treated by transanal re-excision (TAR) following endoscopic removal of malignant rectal polyps (MRP).

Methods

Twenty-three patients were identified between 2000 and 2006 as having undergone TAR following complete gross endoscopic removal of an MRP. All lesions demonstrated close, unclear, or microscopically positive polypectomy margins.

Results

Our population consisted of 13 men and 10 women with a median age of 61 years (range 52–86). Seventeen (74%) patients demonstrated no evidence of residual tumor. Six patients were found to have residual disease (three adenoma, two adenocarcinoma, one positive lymph node). Morbidity was minimal, and there were no mortalities. At a median follow-up of 64.6 months (range 11–90), there have been no recurrences.

Conclusion

We conclude that in approximately one quarter of patients, residual disease is identified following TAR. Given the relatively safety and the low recurrence rate associated with this procedure, TAR may be considered as an alternative to radical resection for MRPs with unsatisfactory margins.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Marcovalerio Melis & David Shibata

  2. Division of Surgical Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

    Renee Gruel

  3. Division of Gastroenterology, University of Maryland School of Medicine, Baltimore, MD, USA

    Peter Darwin

  4. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA

    Cinthia Drachenberg

Authors
  1. Marcovalerio Melis
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  2. Renee Gruel
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  3. Peter Darwin
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  4. Cinthia Drachenberg
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  5. David Shibata
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Corresponding author

Correspondence to David Shibata.

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Melis, M., Gruel, R., Darwin, P. et al. Full thickness transanal re-excision following endoscopic removal of malignant rectal polyps. Int J Colorectal Dis 24, 531–536 (2009). https://doi.org/10.1007/s00384-009-0642-1

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  • DOI: https://doi.org/10.1007/s00384-009-0642-1

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