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Recurrence after transanal endoscopic microsurgery for large rectal adenomas

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Abstract

Background

Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a “tailored” approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma.

Methods

This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated.

Results

Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12–216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4–33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003).

Conclusions

TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence.

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Disclosures

Marco Ettore Allaix, Alberto Arezzo, Paola Cassoni, Federico Famiglietti, and Mario Morino have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Digestive and Colorectal Surgery and Centre for Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy

    Marco Ettore Allaix, Alberto Arezzo, Federico Famiglietti & Mario Morino

  2. Department of Biomedical Sciences and Human Oncology, University of Torino, Turin, Italy

    Paola Cassoni

Authors
  1. Marco Ettore Allaix
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  2. Alberto Arezzo
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  3. Paola Cassoni
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  4. Federico Famiglietti
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  5. Mario Morino
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Correspondence to Mario Morino.

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Allaix, M.E., Arezzo, A., Cassoni, P. et al. Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc 26, 2594–2600 (2012). https://doi.org/10.1007/s00464-012-2238-z

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  • DOI: https://doi.org/10.1007/s00464-012-2238-z

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