Endoscopic trans-anal resection of rectal tumours: critical appraisal of an interdisciplinary approach.
OBJECTIVE
Endoscopic trans-anal resection (ETAR) is an accepted technique for treating benign rectal adenomas that relies on technical expertise with the urological resectoscope. We present our experience with ETAR in an interdisciplinary setting combining the decision-making of the colorectal surgeon with the technical skill of the urologist.


METHODS
Assessment of all patients with adenomas and their subsequent care was organized by the colorectal team. Those with carpet-like rectal adenomas were referred to the urologist for ETAR performed using a Storz-Olympus 27/28Ch resectoscope, with roller-ball for haemostasis and glycine for irrigation.


RESULTS
Twenty-four patients (43-93 years, median 71 years; 14 men and 10 women) underwent 51 ETAR procedures from 1999 to 2005, with a median of two (range 1-6) procedures per patient. Complete clearance was achieved on 25 occasions. Two intra-operative extra-peritoneal perforations occurred which were managed conservatively. There were four cases of postoperative haemorrhage, two of which required a repeat procedure to secure haemostasis. Four patients had postoperative pyrexia that settled with oral antibiotics. Mean tumour distance from the anal verge was 7 cm (range 2-12 cm); the mean tumour area was 8 cm(2) (range 3-20 cm(2)); the mean operating time was 34 min (range 15-60 min) and the mean hospital stay was 32 h (range 24-120 h).


CONCLUSIONS
An interdisciplinary approach to ETAR uses available clinical resources efficiently as the colorectal surgeon does need to acquire the technical skills of endoscopic resection. Our results compare favourably with other published series and this approach can be adopted by any centre where colorectal and urological surgeons work together.
Shaikh
S
S
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Nabi
G
G
O'Kelly
T
T
Swami
S K
SK
D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000188:drug therapy; D013502:General Surgery; D006801:Humans; D033183:Interdisciplinary Communication; D007431:Intraoperative Complications / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014572:Urology
D000900:Anti-Bacterial Agents