Endoscopic transanal resection using the urological resectoscope in the management of patients with rectal villous adenomas.
OBJECTIVE
This study reviewed the outcome of endoscopic transanal resection (ETAR) for the treatment of patients with villous rectal adenomas (VRA).


METHODS
This study included 28 consecutive patients who underwent ETAR for VRA between October 1992 and December 2000. All tumors were believed to be benign (clinical examination, endorectal ultrasonography, multiples biopsies) A retrospective evaluation of the outcome of ETAR was performed.


RESULTS
Thirteen patients (46.4%) had a large VRA with a tumor length of more than 5 cm. The tumor involved the anterior rectal wall in ten cases. Ten patients (35.7%) required more than one procedure. Median operating time was 35 min (range 20-50). Morbidity was 5% ( n=2); no patient died. Median postoperative stay was 3 days (range 1-5). Three patients (9.3%) were confirmed on histology as having adenocarcinoma of the rectum and underwent a conventional surgical procedure. At a median follow-up of 5 years (2.5-10.5), two recurrences were noted.


CONCLUSIONS
Our data suggest that the technique of transanal resection has a limited but valuable place in rectal surgery. ETAR is a simple, minimally invasive, and economical method for treatment of patient with VRA. ETAR should be performed in collaboration with an experienced urological endoscopist. ETAR is a useful addition to the surgeon's armamentarium together with laser destruction and transanal endoscopic microsurgery.
Tuech
Jean-Jacques
JJ
Department of Digestive Surgery, Angers University Hospital, 4 rue Larrey, 49000 Angers, France. TUECHJ@ch-mulhouse.fr.
Pessaux
Patrick
P
Regenet
Nicolas
N
Ziani
Mohamed
M
Ollier
Jean-Claude
JC
Arnaud
Jean-Pierre
JP
D018253:Adenoma, Villous / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome