Predictors of rectal adenoma recurrence following transanal endoscopic surgery: a retrospective cohort study
- 41 Downloads
Transanal endoscopic surgery is the treatment of choice in patients with rectal adenomas that cannot be removed by endoscopy. However, the risk of adenoma recurrence and optimal surveillance is not well defined. The objective of this study was to characterize the timing and frequency of rectal adenoma recurrence after removal by transanal endoscopic surgery and identify recurrence risk factors.
This was a retrospective cohort study of a large, single-center academic institution in Vancouver, BC, Canada. Consecutive patients between May 1, 2007 and September 30, 2016 with pathology-confirmed rectal adenoma treated by primary excision with transanal endoscopic surgery and at least 1 year of confirmed endoscopic follow-up were included. Main outcome measures were recurrence rates following TEM as well as risk factors for recurrence.
297 patients met inclusion criteria. The mean age of patients was 66.5 ± 11.5 years and 57.9% were male. Median follow-up was 623 (range 56–3841) days. A total of 62 recurrences occurred in 41 patients (13.8% of study population). Recurrences were managed with repeat transanal endoscopic surgery or endoscopic resection 67.7% and 25.8% of the time, respectively. Radical resection was required for adenocarcinoma in 4 patients. Recurrence-free survival rates were 93.4% at 1 year, 86.2% at 2 years, and 73.1% at 5 years. After adjusting for individual surgeons, adenoma height, size > 3 cm, high-grade dysplasia, positive margins, and management of the rectal defect, patients who underwent surgery in the latter 5 years of the study had lower odds of recurrence (OR 0.42, 95% CI 0.19, 0.93, p = 0.03).
Rectal adenomas managed by transanal endoscopic surgery are lesions at high risk for recurrence; surveillance should be performed within the first 2 years and continued for a total of at least 5 years. Most recurrences can be successfully treated with repeat TEM or endoscopic resection.
KeywordsTransanal endoscopic microsurgery Rectal adenoma
No sources of funding were provided for this work.
Compliance with ethical standards
T. Chan, A. Karimuddin, M. Raval, P. T. Phang, V. Tang, and C. Brown have no conflicts of interest or financial ties to disclose.
- 5.Burghardt J, Buess G (2005) Transanal endoscopic microsurgery (TEM): a new technique and development during a time period of 20 years. Surg Technol Int 14:131–137Google Scholar
- 9.Chernyshov SV, Shelygin YA, Mainovskaya OA et al (2015) Possibilities of transanal endoscopic microsurgery: the experience of 202 operations. Vopr Onkol 61(6):998–1005Google Scholar
- 11.Government of British Columbia (2013) Follow-up of colorectal polyps or cancer. http://www2.gov.bc.ca/gov/content/health/practitionerprofessional-resources/bc-guidelines/colorectal-cancer-follow-up. Accessed 1 August 2019
- 15.Emmanuel A, Gulati S, Burt M et al (2018) Safe and effective endoscopic resection of massive colorectal adenomas ≥ 8 cm in a Tertiary Referral Center. Dis Colon Rectum 61(8):955–963Google Scholar
- 16.Moss A, Williams SJ, Hourigan LF et al (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64:57–65CrossRefGoogle Scholar
- 29.Accreditation Council for Graduate Medical Education. Minimum case numbers: review committee for colon and rectal surgery. https://www.acgme.org/Portals/0/PFAssets/ProgramResources/060_CRS_Minimum_Case_Numbers.pdf. Accessed 1 April 2018
- 30.Letarte F, Raval M, Karimuddin A et al (2018) Salvage TME following TEM: a possible indication for TaTME. Tech Coloproctol 96(5):280–287Google Scholar