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Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM)

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Abstract

Background

Large sessile adenomas of the rectum, with a diameter greater than 5 cm, have a high risk to undergo malignant transformation. Transanal endoscopic microsurgery (TEM) offers an alternative operation method to low-anterior rectum resection in this potentially benign tumor situation.

Patients

We retrospectively investigated patients with giant adenomas of the rectum (>5 cm) who were treated by TEM over the last 10 years. A total of 33 patients met the criteria and were analyzed for postoperative complications, histology, and incidence of occult adenocarcinoma; residual tumor status; and tumor recurrence.

Results

Partial suture-line insufficiency (n=5, 15%) was the major postoperative complication, but could be managed conservatively in four cases. The residual adenoma status was 18% (n=6), especially in patients with tumors sizes more than 30 cm2. In case of adenoma recurrence (n=4, 12%), a conventional transanal excision (Parks) was applicable, as these tumors were mostly located within the suture-line region of the lower rectum. Incidentally, five carcinomas were found in the specimens. In case of advanced tumors (1×pT2, 1×pT3), anterior rectum resection was carried out, whereas for the early tumors (2×pT1 low risk, 1×1 pTis), no further therapy was added. All patients (adenomas and carcinomas, n=33) were without recurrence during follow-up.

Conclusion

TEM is an alternative method for the resection of large benign rectal tumors located in the mid- and upper third of the rectum. The main postoperative complication is suture-line insufficiency, which generally heals by conservative treatment.

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References

  1. Jahadi MR, Baldwin A Jr (1975) Villous adenomas of the colon and rectum. Am J Surg 130(6):729–732

    Article  PubMed  CAS  Google Scholar 

  2. Stulc JP, Petrelli NJ, Herrera L, Mittelman A (1988) Colorectal villous and tubulovillous adenomas equal to or greater than four centimeters. Ann Surg 207:65–71

    Article  PubMed  CAS  Google Scholar 

  3. Winburn GB (1998) Surgical resection of villous adenomas of the rectum. Am Surg 64(12):1170–1172

    PubMed  CAS  Google Scholar 

  4. Nivatvongs S, Snover DC, Fang DT (1984) Piecemeal snare excision of large sessile colon and rectum polyps: is it adequate? Gastrointest Endosc 30:18–20

    Article  PubMed  CAS  Google Scholar 

  5. Parks AG, Stuart AE (1973) The management of villous tumors of the large bowel. Br J Surg 60:688–695

    Article  PubMed  CAS  Google Scholar 

  6. Featherstone JM, Grabham JA, Fozard JB (2004) Per-anal excision of large, rectal, villous adenomas. Dis Colon Rectum 47:86–89

    Article  PubMed  CAS  Google Scholar 

  7. Said S, Stippel D (1995) Transanal endoscopic microsurgery in large, sessile adenomas of the rectum. Surg Endosc 9:1106–1112

    Article  PubMed  CAS  Google Scholar 

  8. Saclarides TJ (1997) Transanal endoscopic microsurgery. Surg Clin North Am 77:229–238

    Article  PubMed  CAS  Google Scholar 

  9. Swanstrom LL, Smiley P, Zelko J, Cagle L (1997) Video endoscopic transanal–rectal tumor excision. Am J Surg 173:383–385

    Article  PubMed  CAS  Google Scholar 

  10. Morson B (1974) The polyp-cancer sequence in the large bowel. Proc R Soc Med 67:451–457

    PubMed  CAS  Google Scholar 

  11. Hermanek P (1990) Malignant polyps-pathological factors governing clinical management. Curr Top Pathol 81:277–293

    PubMed  CAS  Google Scholar 

  12. Keck JO, Schoetz DJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1995) Rectal mucosectomy in the treatment of giant rectal villous tumors. Dis Colon Rectum 38:233–238

    Article  PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259

    Article  PubMed  Google Scholar 

  15. Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026

    Article  PubMed  Google Scholar 

  16. Welch JP, Welch CE (1976) Villous adenomas of the colorectum. Am J Surg 131:185–191

    Article  PubMed  CAS  Google Scholar 

  17. Buess G, Mentges B, Manncke K (1992) Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163:63–70

    Article  PubMed  CAS  Google Scholar 

  18. Schafer H, Baldus SE, Gasper F, Holscher AH (2005) Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery. Chirurg 76:379–384

    Article  PubMed  CAS  Google Scholar 

  19. Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N (1996) Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 43:183–188

    Article  PubMed  CAS  Google Scholar 

  20. Doniec JM, Lohnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H (2003) Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 46:340–348

    Article  PubMed  Google Scholar 

  21. Stergiou N, Riphaus A, Lange P, Menke D, Kockerling F, Wehrmann T (2003) Endoscopic snare resection of large colonic polyps: how far can we go? Int J Colorectal Dis 18:131–135

    Article  PubMed  CAS  Google Scholar 

  22. Seitz U, Bohnacker S, Seewald S, Thonke F, Soehendra N (2003) Long-term results of endoscopic removal of large colorectal adenomas. Endoscopy 35:41–44

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Str. 9, 50924, Cologne, Germany

    Hartmut Schäfer & Arnulf H. Hölscher

  2. Institute of Pathology, University of Cologne, Cologne, Germany

    Stefan E. Baldus

Authors
  1. Hartmut Schäfer
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  2. Stefan E. Baldus
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  3. Arnulf H. Hölscher
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Correspondence to Hartmut Schäfer.

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Schäfer, H., Baldus, S.E. & Hölscher, A.H. Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 21, 533–537 (2006). https://doi.org/10.1007/s00384-005-0025-1

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