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International Journal of Colorectal Disease

, Volume 10, Issue 2, pp 112–116 | Cite as

Transanal local resection for benign and malignant rectal tumours

  • E. E. Piccinini
  • G. Ugolini
  • G. Rosati
  • A. Conti
Original Articles

Abstract

Local therapy has been widely reported and accepted for benign tumours and carefully selected cancers of the rectum. Thirty-three patients with benign or malignant low rectal tumors have undergone a prospective evaluation after local resection with transanal electroresection as described by Faivre. Patients were divided in three groups: 1) local excision of benign tumours (12 patients), 2) curative resection for localised malignant tumours (7 patients) and 3) palliative local resection for malignant tumours (14 patients). The complications included transient incontinence and rectal bleeding. Patients have been followed for a mean period of 18 months (1–54). In group 3 there were four (28%) recurrences. The remainder of the patients with malignant tumours have been free of disease on follow-up. Although it is ideal for benign neoplasms, further follow-up is needed to determine its true indication in malignant lesions.

Keywords

Benign Tumour Excision Locale Rectal Tumor Local Resection Benign Neoplasm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Le traitement local de tumeurs bénignes et de cancers du rectum soignement sélectionnés a été largement publié et reconnu. Trente-trois patients porteurs de lésions bénignes ou malignes de la partie distale du rectum ont été soumis à une évaluation prospective après résection locale selon la technique d'électro-transition transanale décrite par Faivre. Les patients ont été divisés en trois groupes: 1) excision locale pour une lésion bénigne (12 patients), 2) résection curative pour une tumeur maligne localisée (7 patients) et 3) excision locale palliative pour une tumeur maligne (14 patients). Les complications comportent une incontinence passagère et un saignement rectal. Les patients ont été suivis pendant une période moyenne de 18 mois (1 à 54 mois); quatre récidives (28%) se sont développées chez les patients du groupe 3). Les autres patients avec des lésions malignes n'ont pas développé de récidive tumorale durant la période de suivi. Ce traitement est idéal pour des lésons bénignes et d'autres études avec un suivi plus long sont nécessaires pour déterminer la place de ce traitement en cas de lésion maligne.

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References

  1. 1.
    Miles WE (1908) A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 2:812Google Scholar
  2. 2.
    Nivatvongs S, Wolf BG (1992) Technique of per anal excision for carcinoma of the low rectum. World J Surg 16:447–450Google Scholar
  3. 3.
    Killingback M (1992) Local excision of carcinoma of the rectum: indications. World J Surg 16:437–446Google Scholar
  4. 4.
    Decosse J, Wong RJ, Quan SHQ, Friedman NB, Sternberg SS (1989) Conservative treatment of distal rectal cancer by local excision. Cancer 63:219–223Google Scholar
  5. 5.
    Sakamoto G, MacKeigan JM, Senagore AJ (1991) Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 34:880–885Google Scholar
  6. 6.
    Minsky BD, Rich R, Recht A, Harvey W, Mies C (1989) Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer. Cancer 63:1421–1429Google Scholar
  7. 7.
    Faivre J (1979) Abord proctologique des tumeurs villeuses du rectum. L'electroresection transanale par lambeau tracteur. Ann Gastroenterol Hepathol 15:313–318Google Scholar
  8. 8.
    Coco C, Magistrelli P, Granone P, Roncolini G, Picciocchi A (1992) Conservative surgery for early cancer of the distal rectum. Dis Colon Rectum 35:131–136Google Scholar
  9. 9.
    Faivre J, Chaume JC (1982) L'electro-resection trans-anale des tumeurs benignes et malignes du rectum par lambeau tracteur. A propos de 267 cas. Ann Gastroenterol Hepatol 18:79–83Google Scholar
  10. 10.
    Pello MJ (1987) Transanal excision of large sessile villous adenomas using an endorectal traction flap. Surg Gynecol Obstet 164:280–282Google Scholar
  11. 11.
    Faivre J (1981) Transanal electroresection of rectal tumor by means of tractable mucocutaneous anal flap. Coloproctology 2:77–80Google Scholar
  12. 12.
    Stephenson BM, Shandall AA, Ng KJ, Price-Thomas JM (1992) Endoscopic transanal resection of large villous tumours of the rectum. Ann Royal Coll Surg Eng 74:54–58Google Scholar
  13. 13.
    Buess G, Mentges B, Manncke K, Starlinger M, Becker HD (1992) Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163:63–70Google Scholar
  14. 14.
    Berry AR, Souter RG, Campbell WB, McC Mortensen NJ, Kettlewell MGW (1990) Endoscopic transanal resection of rectal tumours — a preliminary report of its use. Br J Surg 77:134–137Google Scholar
  15. 15.
    Mason AY (1970) Surgical access to the rectum: a trans-sphincteric exposure. Proc Roy Soc Med 63 [Suppl]:91–94Google Scholar
  16. 16.
    Eisenstat TE, Oliver GC (1992) Electrocoagulation for adenocarcinoma of the low rectum. World J Surg 16:458–462Google Scholar
  17. 17.
    Hughes EP Jr, Veidenheimer MC, Corman ML, Coller JA (1982) Electrocoagulation of rectal cancer. Dis Colon Rectum 25:215–218Google Scholar
  18. 18.
    Tacke W, Paech S, Kruis W, Stuetzer H, Mueller JM, Ziegenhagen DJ, Zehnter E (1993) Comparison between endoscopic laser and different surgical treatments for palliation of advanced rectal cancer. Dis Colon Rectum 36:377–382Google Scholar
  19. 19.
    McGowan I, Barr H, Krasner N (1989) Palliative laser therapy for inoperable rectal cancer: does it work? Cancer 63:967Google Scholar
  20. 20.
    Dickinson AJ, Savage AP, McC Mortensen NJ, Kettlewell MGW (1993) Long-term survival after endoscopic transanal resection of rectal tumors. Br J Surg 80:1401–1404Google Scholar
  21. 21.
    Wetherall AP, Williams NMA, Kelly MJ (1993) Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer. Br J Surg 80:788–793Google Scholar
  22. 22.
    Osborne DR, Higgins AF, Hobbs KEF (1978) Cryosurgery in the management of rectal tumours. Br J Surg 65:859–861Google Scholar
  23. 23.
    Papillon J (1975) Intracavitary irradiation of early rectal cancer for cure. Cancer 36:696Google Scholar
  24. 24.
    Parturier-Albot M, Arnous J (1982) A propos de la lecon de J. Faivre et J.C. Chaume: interet de l'association du lambeau tracteur et de la radiotherapie de contact endocavitaíre dans certaines formes de cancer du rectum. Comparaison avec la biopsie exerese. Ann Gastroenterol Hepatol 18:85–86Google Scholar
  25. 25.
    Hildebrandt U, Feifel G (1985) Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 28:42–46Google Scholar
  26. 26.
    Hermaneck P, Sobin LH (eds) (1987) TNM classification of malignant tumors, 4th edn. Springer, Berlin Heidelberg New York, UICC.Google Scholar
  27. 27.
    Lavery IC (1990) Curative local procedure rectal cancer. Semin Colon Rectal Surg 1:25–31Google Scholar
  28. 28.
    The standards task force American Society of Colon and Rectal Surgeons (1993) Practice parameters for the treatment of rectal carcinoma — supporting documentation. Dis Colon Rectum 36:991–1006Google Scholar
  29. 29.
    Lock MR, Ritchie JK, Hawley PR (1993) Reappraisal of radical local excision for carcinoma of the rectum. Br J Surg 80:928–929Google Scholar
  30. 30.
    Nelson JC, Nim AF, Thomford NR (1987) Criteria for the selection of “early” carcinomas of the rectum. Are they valid? Arch Surg 122:533–536Google Scholar
  31. 31.
    Hind R, Rew D, Johnson C (1992) Surgical excision alone is adequate treatment for primary colorectal cancer. Ann Royal Coll Surg Engl 74:63–67Google Scholar
  32. 32.
    Whiteway J, Nicholls RJ, Morson BC (1985) The role of surgical local excision in the treatment of rectal cancer. Br J Surg 72:694–697Google Scholar
  33. 33.
    Galandiuk S, Fazio VW, Jagelman DG (1987) Villous and tubulovillous adenomas of the colon and rectum: a retrospective review, 1964–1985. Am J Surg 153:41–47Google Scholar
  34. 34.
    Biggers OR, Beart RW Jr, Ilstrup DM (1986) Local excision of rectal cancer. Dis Colon Rectum 29:374–377Google Scholar
  35. 35.
    Morson BC (1985) Histologic criteria for local excision. Br J Surg 72:553–556Google Scholar
  36. 36.
    Huddy SPJ, Husband EM, Cook MG, Gibbs NM, Marks CG, Heald RJ (1993) Lymph node metastasis in early rectal cancer. Br J Surg 80:1457–1458Google Scholar
  37. 37.
    Beynon J, McC Mortensen NJ, Channer JL, Rigby H (1992) Rectal endosonography accurately predicts depth of penetration in rectal cancer. Int J Colorect Dis 7:4–7Google Scholar
  38. 38.
    Orrom WJ, Wong WD, Rothenberger DA, Jensen LL, Goldberg SM (1990) Endorectal ultrasound in the preoperative staging of rectal tumors. Dis Colon Rectum 33:654Google Scholar
  39. 39.
    Durdley P, Williams NS (1992) Pre-operative evaluation of patients with low rectal carcinoma. World J Surg 16:430–436Google Scholar
  40. 40.
    Feifel G, Hildebrandt U (1992) New diagnostic imaging in rectal cancer: endosonography and immunoscintigraphy. World J Surg 16:841–847Google Scholar
  41. 41.
    Katsura Y, Yamada K, Ishizawa T, Yoshinaka H, Shimazu H (1992) Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum 35:362–368Google Scholar
  42. 42.
    Rifkin MD, Ehrlich SM, Marks G (1989) Staging of rectal carcinoma: prospective comparison of endorectal US and CT. Radiology 170:319–322Google Scholar
  43. 43.
    Marks G, Mohiuddin MM, Masoni L, Pecchioli L (1990) High-dose preoperative radiation and full-thickness local excision a new option for patients with select cancers of the rectum. Dis Colon Rectum 33:735–740Google Scholar
  44. 44.
    Rouanet P, Saint Aubert B, Fabre JM, Astre C, Liu JZ, Dubois JB, Joyeux H, Solassol C, Pujol H (1993) Conservative treatment for low rectal carcinoma by local excision with or without radiotherapy. Br J Surg 80:1452–1456Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • E. E. Piccinini
    • 1
  • G. Ugolini
    • 1
  • G. Rosati
    • 1
  • A. Conti
    • 1
  1. 1.Istituto di Clinica Chirurgica III, Policlinico Sant'OrsolaUniversità degli Studi di BolognaBolognaItaly

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