Transanal excision of anorectal lesions--a single centre experience.
BACKGROUND
Transanal excision is commonly used to treat lesions of the anorectum. It avoids the morbidity of radical pelvic surgery, while allowing for complete histopathological examination of the lesion.


OBJECTIVE
The aim of this study was to look at the spectrum of disease treated by transanal excision, and their outcomes, in a tertiary care institute.


METHODS
Records of patients who underwent transanal excision between 2004 and 2008 were reviewed. Patients were divided into three groups. (1) Resection for benign disease (2) Curative and (3) Palliative resection for malignant disease.


RESULTS
Forty six patients underwent transanal excision, 21 for benign and 25 for malignant disease, 20 with curative and 5 with palliative intent. Tubulovillous adenomas and hyperplastic polyps were the commonest benign lesions. The mean follow up was 18.6 months (4-49). There was one recurrence and one patient returned with liver metastasis. Seventeen patients with adenocarcinoma, two with melanoma and one with verrucous carcinoma underwent curative resection. Three required a second local excision and two abdominoperineal excision. Mean follow up was 28 months (4-63). There were three recurrences, one requiring a local excision and two abdominoperineal excision. Four patients with malignant melanoma and one with adenocarcinoma underwent palliative resection. All these patients had good symptom palliation.


CONCLUSIONS
Transanal excision, when technically feasible, remains the treatment of choice for benign disease of the rectum. It offers good palliation of local symptoms in advanced malignant disease. It can be used in a carefully selected group of patients with early rectal cancer.
Mittal
Rohin
R
Department of Surgery Unit 5 (Colorectal Surgery), Christian Medical College and Hospital, Vellore, Tamil Nadu, India. rohinmittal@gmail.com
Perakath
Benjamin
B
Chase
Suchita
S
Jesudason
Mark Ranjan
MR
Nayak
Sukria
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome