Treatment strategies and outcomes for rectal villous adenoma from a single-center experience.
OBJECTIVE
To analyze a 13-year, single-surgeon experience with villous adenoma of the rectum with respect to procedure, complications, recurrence, and cancer incidence.


METHODS
Retrospective review of patient and tumor characteristics, procedure, recurrence, and complications.


METHODS
University hospital.


METHODS
Patients who underwent excision of rectal villous adenoma.


METHODS
Complication, recurrence, and malignancy rates.


RESULTS
Thirty-six patients underwent 30 transanal and 10 transabdominal excisions. Mean age was 66 years (range, 41-86 years) and mean follow-up was 25 months (range, 0.5-132 months). Mean tumor size was 3.0 cm (range, 0.5-11 cm) and the mean distance of the tumor from the anal verge was 4.9 cm (range, 0-10 cm). Preoperatively, 18 (45%) lesions harbored low-grade dysplasia while 17 (43%) had high-grade dysplasia. Postoperative pathology was discordant in 50% of patients, including 5 of 40 lesions (13%) that were recategorized as invasive cancer. Tumor size did not correlate with malignancy. The complication rate was significantly lower in transanal compared with transabdominal excisions (3.6% vs 50%, P = .005). There were 4 (12.5%) benign recurrences, all after transanal excisions.


CONCLUSIONS
Complete excision is warranted for rectal villous adenomas, as biopsies were accurate only 50% of the time, and 1 in 8 patients had unsuspected cancer found after excision. Transanal excision with negative margins is associated with low recurrence and complication rates and is the preferred approach, even with large lesions.
Cho
Sungeyun David
SD
Oregon Health & Science University, Portland, OR 97239, USA.
Herzig
Daniel O
DO
Douthit
Miriam A
MA
Deveney
Karen E
KE
D018253:Adenoma, Villous / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies