Abstract
Purpose
Complex rectal polyps may present a clinical challenge. The study aim was to assess different treatment modalities required in the management of patients referred for transanal endoscopic microsurgery.
Methods
Patients referred with complex rectal polyps from 1998 to 2008 were entered prospectively to a colorectal database. These data was analyzed for referral pattern, histology, surgical procedures performed, and subsequent outcome.
Results
Of the 209 patients referred (101 female, 108 male, median age of 65 years, range of 24–89), 132 (63%) were deemed suitable for transanal endoscopic microsurgery. Seventeen patients required a second staged procedure; three patients required an anterior resection at time of index surgery. Seventeen patients referred for transanal endoscopic microsurgery went direct to anterior resection, 37 underwent snare polypectomy (SP), and 17 patients underwent transanal excision. Six patients had no surgery (three unfit for anesthesia and three had no residual lesions). Thus, 37% of the patients referred for transanal endoscopic microsurgery required a different treatment modality.
Conclusions
Majority of patients referred to our unit with complex rectal polyps were suitable for transanal endoscopic microsurgery. However, this study highlights that in offering a transanal microsurgery service, one should be prepared for a diversity of pathology necessitating a range of management options.
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References
Morson BC (1976) Genesis of colorectal cancer. Clin Gastroenterol 5:505–525
Piccinini EE, Ugolini G, Rosati G, Conti A (1995) Transanal local resection for benign and malignant rectal lesions. In J Colorectal Dis 10:112–116
Christiansen J (1980) Excision of mid rectal lesions by the Kraske sacral approach. Br J Surg 67:651–652
Buess G, Kipfmuller K, Hack D, Grubner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75
Buess GF, Raestrup H (2001) Transanal endoscopic microsurgery. Surg Oncol Clin N Am 10:709–731
Burghardt J, Buess G (2005) Transanal endoscopic microsurgery (TEM): a new technique and development during a time period of 20 years. Surg Technol Int 14:131–137
Schafer H, Baldus SE, Holscher AH (2006) Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 21:533–537
De Graff EJ, Doornebosch PG, Stassen LP, Debets JM, Tetteroo GW, Hop WC (2002) Transanal endoscopic microsurgery for rectal cancer. Eur J Cancer 38:904–910
Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D et al (2002) Long-term results of local excision for rectal cancer. Ann Surg 236:522–530
Sakamoto GD, MacKeigan JM, Senagore AJ (1991) Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 34:880–885
Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A et al (2009) A predictive model for local recureence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290
MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460
Fucini C, Segre D, Trompetto M (2004) Local excision of rectal polyp: indications and techniques. Tech Coloproctol 8(Suppl 2):s300–s304
Said S, Huber P, Pichlmaier H (1993) Technique and clinical results of endorectal surgery. Surgery 113:65–75
Rabau M (2008) Transanal resection of rectal neoplasms using the harmonic scapel. Tech Coloproctol 12:247–249
Hermanek P, Fruhmorgen P, Guggenmoos-Holzmann I, Altendorf A, Matek W (1983) The malignant potential of colorectal polyps: a new statistical approach. Endoscopy 15:16–20
Ramirez M, Schierling S, Papanconstantinou HT, Scott Thomas J (2008) Management of the malignant polyp. Clin Colon Rectal Surg 21:286–290
Saclarides TJ (2007) TEM/local excision: indications, techniques, outcomes, and the future. J Surg Oncol 96:644–650
Papagrigoriadis S (2006) Transanal endoscopic micro-surgery (TEMS) for the management of large or sessile rectal adenomas: a review of the technique and indications. Int Semin Surg Oncol 3:13
Floyd ND, Saclarides TJ (2006) Transanal endoscopic microsurgical resection of pT1 rectal tumours. Dis Colon Rectum 49:164–168
Ganai S, Kanumuri P, Rao RS, Alexander AI (2006) Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 13:547–556
Borschitz T, Heintz A, Junginger T (2006) The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 49:1492–1506
Kato H, Sakamoto T, Yamada R, Tsunoda C, Haga S (2008) Endoscopic mucosal resection (EMR) for colorectal lesions and lesion-lifted condition as an indicator of the tumor invasion. Ann Cancer Res Ther 16(1):25–30
Disclosures
Drs. Myles R Joyce, Emmanuel Eguare, Fiona Kiernan, Niall Swan, Paul Crotty, Paul Neary, and Frank B.V. Keane have no financial disclosures or conflict of interest in respect of this manuscript.
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Joyce, M.R., Eguare, E., Kiernan, F. et al. Complex rectal polyps: other treatment modalities required when offering a transanal endoscopic microsurgery service. Int J Colorectal Dis 26, 1177–1182 (2011). https://doi.org/10.1007/s00384-011-1212-x
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DOI: https://doi.org/10.1007/s00384-011-1212-x