Abstract
Background
The authors present their experience with rectal adenomas managed by transanal endoscopic microsurgery (TEM). The goals of this study were to examine our institution’s experience by evaluating surgical morbidity, mortality, and local recurrence rate.
Methods
This retrospective study investigated 402 patients who underwent TEM a for preoperative diagnosis of adenoma from January 1993 to October 2008. The mean age was 65 years (range = 22–92 years). All patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate.
Results
No 30-day perioperative mortality occurred. No conversion to laparoscopic or open procedures was reported. Minor complications occurred in 28 (7%) patients, whereas major complications were found only in 2 (0.5%) patients. Definitive histology confirmed adenomas in 366 cases (91%). At a mean follow-up of 84 months (range = 1–190 months), 16 (4%) adenomas recurred and were successfully retreated by TEM [14 cases (87.5%)] and by conventional surgery [2 patients (12.5%)]. No further recurrences were observed at subsequent follow-up.
Conclusion
The findings warrant the conclusion that TEM is a safe, effective treatment for rectal adenomas where endoscopic removal is not applicable and has low morbidity and no mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cocilovo C, Smith LE, Stahl T, Douglas J (2003) Transanal endoscopic excision of rectal adenomas. Surg Endosc 17:1461–1463
Buess G, Hutter F, Theiss J, Bobel M, Isslhard W, Pichlmaier H (1984) Das Syste fur die transanale endoskopische Rectumoperation. Chirurg 55:677–680
Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284
Blanco GF, Giordano M, Torelli I, Di Bella F (1999) Our experience in the transanal excision of tubulo-villosous adenomas of the rectum. Minerva Chir 54:477–484
Featherstone JM, Grabham JA, Fozard JB (2004) Per-anal excision of large, rectal, villous adenomas. Dis Colon Rectum 47:86–89
Renzulli P, Maurer CA, Netzer P, Buchler MW (2004) Surgical management of large sessile villous and tubulovillous adenomas of lower rectum. Dig Surg 21:287–292
Nahas SC, Imperiale AR, Araujo SE, Aisaka AA, Sobrado Junior CW, Habr-Gama A, Pinotti HW (1998) Villous and tubulovillous adenomas of the colon and rectum. Rev Hosp Clin Fac Med Sao Paulo 53:162–168
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
Bretagnol F, Merrie A, George B, Warren BF, Mrtensen NJ (2007) Local excision of rectal tumour by transanal endoscopic microsurgery. Br J Surg 94:627–633
Nastro P, Beral D, Hartley J, Monson JRT (2005) Local excision of rectal cancer: review of literature. Dig Surg 22:6–15
Blair S, Ellenhorn JD (2000) Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology. Am Surg 66:817–820
Guerrieri M, Feliciotti F, Baldarelli M, Zenobi P, De Sanctis A, Lezoche G, Lezoche E (2003) Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years’ experience. Dig Liver Dis 35:876–880
Lee W, Lee D, Choi S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17:1283–1287
Lezoche E, Guerrieri M, Paganini AM, Feliciotti F (2002) Long term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 26:1170–1174
Lloyd GM, Sutton CD, Marshall LJ, Baragwanath P, Jameson JS, Scott AD (2002) Transanal endoscopic microsurgery—lessons from a single UK centre series. Colorectal Dis 4:467–472
Platell C, Denholm E, Making G (2004) Efficacy of transanal endoscopic microsurgery in the management of rectal polyps. J Gastroenterol Hepatol 19:767–772
Winde G, Nottberg H, Keller R, Schmid KW, Bunte H (1996) Surgical cure for early rectal carcinomas (T1). Transanal Endoscopic Microsurgery vs. anterior resection. Dis Colon Rectum 39:969–976
Bertone A, Spandre M, Gemme C, Cavallero M, Rossini FT (1989) Laser therapy in the treatment of tumors of the rectum and inoperable polyps. Personal series. Minerva Dietol Gastroenterol 35:237–240
Regairaz C, Le Pivert P, Bertheas D, Cuilleret J (1980) The treatment of villous tumors of the rectum by cryosurgery. A report of 10 cases. J Chir 117:241–243
Ruget O, Burtin P, Ben Bouali AK, D’Aubigny N, Boyer J (1993) Laser therapy of villous rectocolonic tumors. Evaluation of results by multivariate analysis. Gastroenterol Clin Biol 17:938–943
Gavagan JA, Whiteford MH, Swanstrom LL (2004) Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complication. Am J Surg 187:360–364
Lezoche E, Guerrieri M, Paganini A, Feliciotti F, Di Pietrantonj F (1996) Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors? Surg Endosc 10:736–741
Dafnis G, Pahlman L, Raab Y, Gustafsson UM, Graf W (2004) Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis 6:336–342
Demartines N, von Flue MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumours: indications and results. World J Surg 25:870–875
Winburn GB (1998) Surgical resection of villous adenomas of the rectum. Am Surg 64:1170–1173
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guerrieri, M., Baldarelli, M., de Sanctis, A. et al. Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24, 445–449 (2010). https://doi.org/10.1007/s00464-009-0585-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0585-1