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Safety and long-term results of endoscopic transanal resection in treating rectal adenomas: 15 years’ experience

Abstract

Background

Endoscopic transanal resection (ETAR) is a scarcely used technique to treat large or sessile rectal adenomas not amenable to polypectomy. The purpose of this study was to evaluate safety and long-term results of ETAR in treating rectal adenomas in three hospitals over 15 years.

Methods

Patients who underwent ETAR during 1996–2010 were retrospectively analyzed with respect to patient, adenoma, and operative characteristics, earlier operations, complications, follow-up time, recurrence rates, recurrence treatment, and cancer incidence.

Results

Ninety-two patients underwent a total 111 ETARs to treat rectal adenoma. The mean age of patients was 71 years, and the median ASA class 3. Twenty-eight patients previously had received other treatments for rectal adenoma. Incidental carcinoma was found in eight patients. Sixty-seven adenomas were treated with only one ETAR and 17 with two or three ETARs. Sixty-seven patients did not have a recurrence, whereas 14 patients had an adenoma recurrence and 3 patients developed invasive carcinoma during a mean follow-up of 30 months. Complications occurred in 14 patients; all were minor, except for one explorative laparotomy without findings. No mortalities or conversions to open surgery occurred.

Conclusions

ETAR is a minimally invasive and safe technique with inexpensive instrumentation to treat rectal adenomas that are not amenable to polypectomy. Adenoma recurrence rate was 15 % and cancer incidence 3 % in follow-up.

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Fig. 1

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Acknowledgments

The authors thank Anna Kattan for narration of the supplementary video.

Disclosures

Drs. Sallinen, Santti, Liukkonen, Hellström, Mäkelä, Puolakka, and Paajanen have no conflict of interest or financial ties to disclose. This study was funded by governmental competitive research funds (EVO) of South Karelia Central Hospital.

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Correspondence to Ville Sallinen.

Electronic supplementary material

464_2013_2885_MOESM1_ESM.mov

Supplementary video. Endoscopic transanal resection (ETAR) for rectal adenoma in a female patient. A case demonstration. Surgeon: Veli-Matti Puolakka. Narration: Anna Kattan. Edited: Ville Sallinen (MOV 14761 kb)

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Sallinen, V., Santti, H., Liukkonen, T. et al. Safety and long-term results of endoscopic transanal resection in treating rectal adenomas: 15 years’ experience. Surg Endosc 27, 3431–3436 (2013). https://doi.org/10.1007/s00464-013-2885-8

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Keywords

  • Rectal cancer
  • TEM
  • EMR
  • ETAR
  • Polyp
  • Urologic resectoscope