Surgical management of large sessile villous and tubulovillous adenomas of the lower rectum.
BACKGROUND
Large sessile adenomas of the rectum are premalignant lesions necessitating complete removal.


METHODS
We reviewed the data on 20 consecutive patients with large (>or=2 cm) sessile villous and tubulovillous adenomas of the lower two thirds of the rectum (<or=11 cm from the anal verge). Median (range) adenoma diameter and distance from the anal verge were 5 (2-8) and 7 (4-11) cm, respectively. All 11 patients with an adenomatous circumferential involvement of >or=50% or an endosonographic staging of >or=uT2 underwent a low anterior resection of the rectum. The remaining 9 patients underwent a posterior full-thickness local bowel wall resection (modified Mason procedure). The median (range) follow-up period was 3.8 (0.7-8.2) years.


RESULTS
Preoperative biopsy examination successfully excluded invasive carcinoma. Overstaging, however, occurred in 9 of 12 patients (75%) undergoing endosonography, resulting in surgical overtreatment of 4 patients. A curative resection (R0) was always achieved. Five patients had complications, but there was no in-hospital mortality and no cases of local recurrence. 4 out of 19 patients complained of minor stool incontinence, and 3 patients reported incomplete rectal emptying or constipation. Fourteen patients described the operative result as excellent (n = 7) or good (n = 7).


CONCLUSIONS
Endosonography may lead to overstaging and overtreatment. An individualized approach based on the degree of adenomatous circumferential involvement and endosonographic staging showed no mortality, low morbidity, no local recurrence, and good functional medium-term results.
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland.
Pietro
P
Renzulli
Christoph A
CA
Maurer
Peter
P
Netzer
Markus W
MW
Büchler
D018253:Adenoma, Villous / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011230:Precancerous Conditions / Q000601:surgery*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome