Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years' experience.
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.


CONCLUSIONS
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.
Guerrieri
Mario
M
Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I, Università Politecnica delle Marche, Ancona, Italy. guerrieri.m@libero.it
Baldarelli
Maddalena
M
de Sanctis
Angelo
A
Campagnacci
Roberto
R
Rimini
Massimiliano
M
Lezoche
Emanuele
E
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult