Abstract
The clinical and long-term results of 286 cases encountered from 1983 to 1993 in our Department of Surgery regarding the local excision of large, sessile rectal adenomas (>2cm2) by the endoscopic surgical method and the influence of this selected series of adenomas on age, sex, size, grade of dysplasia, and architecture are subjects of this study. Histologically proven rectal carcinomas as well as nonneoplastic polyps were excluded from this trial.
Early postoperative complications amounted to 3.4%. The 1-year and 5-year recurrence rates ±SE of adenomas were 1.2±0.7% and 7.0±1.9%, respectively. Remarkably, there was no significant relationship between the histological type of the adenoma and the grade of dysplasia nor between the size and grade of dysplasia. However, there was a significant relationship between the size and histological type of the adenoma (P<0.01).
With the endoscopic minimal-invasive system, we are able to achieve a superior rate of recurrence compared to any other local treatment as well as a more favorable operative result compared to extensive surgical procedures.
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Adachi M, Muto T, Morioka Y, Ikenaga T, Hara M (1988) Flat adenoma and flat mucosal carcinoma (IIb type)—a new precursor of colorectal carcinoma? Dis Colon Rectum 31: 236–243
Bedgoni G, Bertoni G, Ricci E, Conigliaro R, Pedrazzoli C, Rossi G, Meinero M, Gardini G, Contini S (1986) Colonoscopic excision of large and giant colorectal polyps. Dis Colon Rectum 29: 831–835
Bueß G, Kipfmüller K, Ibald R, Heintz A, Hack D, Braunstein S, Gabbert (1988) Clinical results of transanal endoscopic microsurgery. Surg Endosc 2: 245–250
Chantereau MJ, Faivre J, Boutron MC, Piard F, Arveux P, Bedenne L, Hillon P (1992) Epidemiology, management, and prognosis of malignant large bowel polyps within a defined population. Gut 33: 259–263
Curley StA, Roh MS, Rich TA (1989) Surgical therapy of early rectal carcinoma. Hematol Oncol Clin North Am 3: 87–102
Fielding LP, Stewart-Brown S, Dudley HAF (1978) Surgeon-related variables and the clinical trial. Lancet 2: 778–779
Galandiuk S, Fazio VW, Jagelman DG, Lavery IC, Weakley FA, Petras RE, Badhwaar K, McGonagle B, Eastin K, Sutton T (1987) Villous and tubulovillous adenomas of the colon and rectum. A retrospective review 1964–1985. Am J Surg 153: 41–47
Gall FP, Hermanek P (1988) Cancer of the rectum—local excision. Surg Clin North Am 68: 1353–1365
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD (1985) Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 89: 328–336
Hager Th, Gall FP, Hermanek P (1983) Local excision of cancer of the rectum. Dis Colon Rectum 26: 149–151
Hermanek P (1990) Malignant polyps—pathological factors governing clinical management. Curr Top Pathol 81: 277–293
Heintz A, Braunstein St, Menke H (1992) Lokale Exzision von Rektumtumoren. Indikationen, präoperative Diagnostik, Operationstechnik und Ergebnisse. Med Klinik 87: 236–241
Hermanek P, Frühmorgen P, Guggenmoos-Holzmann I, Altendorf A, Matek W (1983) The malignant potential of colorectal polyps—a new statistical approach. Endoscopy 15: 16–20
Hanley PH, Hine MO, Ray JE, McPherson F, Hibbert WA (1962) Villous tumors; experience with 163 patients. South Med J 55: 233–238
Holdsworth PJ, Johnston D, Chalmers AG, Chennells AG, Dixon MF, Finan PJ, Primrose JN, Quirke P (1988) Endoluminal ultrasound and the computed tomography in the staging of rectal cancer. Br J Surg 75: 1019–1022
Jahadi MR, Baldwin A (1975) Villous adenomas of the colon and rectum. Am J Surg 130: 729–732
Konishi F, Morson BC (1982) Pathology of colorectal adenomas: a colonoscopic survey. J Clin Pathol 35: 830–841
Kuramato S, Oohara T (1988) Minute cancers arising de novo in the human large intestine. Cancer 61: 829–834
Lawrence MA, Goldberg StM (1989) Local excision for selected colorectal carcinomas. Baillieres Clin Gastroenterol 3: 727–737
Morson B (1974) The polyp-cancer sequence in the large bowel. Proc R Soc Med 67: 451–457
World Health Organisation (1976) Histological Typing of intestinal tumours. In: Morson BC, Sobin LM (eds) International histological classification of tumours, volume 15. WHO, Geneva, p 56
Muto T, Kamiya J, Sawada T, Morioka Y (1983) Morphogenesis of human colonic cancer. Dis Colon Rectum 26: 257–262
Muto T, Bussey HJR, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36: 2251–2270
Nivatvongs S, Snover DC, Fang DT (1984) Piecemeal snare excision of large sessile colon and rectal polyps: is it adequate? Gastrointest Endosc 30: 18–20
Nöthinger F (1985) Technique and results of peranal excision of rectal malignoma. Helv chir Acta 52: 325–327
Polard SG, Everett WG (1992) Endoscopic transanal resection of large villous tumours of the rectum. Ann R Coll Surg Engl 74: 227–228
Pollard CW, Nivatvongs S, Rojanasakul A, Reiman HM, Dozios RR (1992) The fate of patient following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum 35: 933–937
Rothenberger DA, Wong WD (1992) Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg 16: 478–485
Said S, Huber P, Pichlmaier H (1993) Technique and clinical results of endorectal surgery. Surgery 113: 65–75
Said S, Buess G, Huber P (1994) Minimally invasive surgery and new technology. In: Steichen FM, Welster R (eds) Transanal endoscopic surgery. Quality Medical Publishing, St Louis, MO, pp 392–400
Stein BL, Coller JA (1993) Management of malignant colorectal polyps. Surg Clin North Am 73: 47–66
Stryker StJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL (1987) Natural history of untreated colonic polyps. Gastroenterology 93: 1009–1013
Tjandra JJ, Cuthbertson AM, Penfold C (1990) Sessile adenomas of the rectum: a personal series 1974–1984. Aust N Z J Surg 60: 883–886
Vatn MH, Stalsberg H (1982) The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer 49: 819–825
Welch JP, Welch CE (1976) Villous adenomas of the colorectum. Am J Surg 131: 185–191
Williams ChB, Bedenne L (1990) Management of colorectal polyps: is all the effort worthwhile? J Gastroenterol Hepatol 1(Suppl): 144–165
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Said, S., Stippel, D. Transanal endoscopic microsurgery in large, sessile adenomas of the rectum. Surg Endosc 9, 1106–1112 (1995). https://doi.org/10.1007/BF00188997
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DOI: https://doi.org/10.1007/BF00188997