title: Safety and long-term results of endoscopic transanal resection in treating rectal adenomas: 15 years' experience.
abstract: BACKGROUND
  Endoscopic transanal resection (ETAR) is a scarcely used technique to treat large or sessile rectal adenomas not amenable to polypectomy. The purpose of this study was to evaluate safety and long-term results of ETAR in treating rectal adenomas in three hospitals over 15 years.
  
  
  METHODS
  Patients who underwent ETAR during 1996-2010 were retrospectively analyzed with respect to patient, adenoma, and operative characteristics, earlier operations, complications, follow-up time, recurrence rates, recurrence treatment, and cancer incidence.
  
  
  RESULTS
  Ninety-two patients underwent a total 111 ETARs to treat rectal adenoma. The mean age of patients was 71 years, and the median ASA class 3. Twenty-eight patients previously had received other treatments for rectal adenoma. Incidental carcinoma was found in eight patients. Sixty-seven adenomas were treated with only one ETAR and 17 with two or three ETARs. Sixty-seven patients did not have a recurrence, whereas 14 patients had an adenoma recurrence and 3 patients developed invasive carcinoma during a mean follow-up of 30 months. Complications occurred in 14 patients; all were minor, except for one explorative laparotomy without findings. No mortalities or conversions to open surgery occurred.
  
  
  CONCLUSIONS
  ETAR is a minimally invasive and safe technique with inexpensive instrumentation to treat rectal adenomas that are not amenable to polypectomy. Adenoma recurrence rate was 15% and cancer incidence 3% in follow-up.
authors.affiliation: Department of Surgery, South Karelia Central Hospital, Valto Käkelän Katu 1, 53130 Lappeenranta, Finland. ville.sallinen@helsinki.fi
authors.forename: Ville
authors.initials: V
authors.lastname: Sallinen
authors.forename: Henrikki
authors.initials: H
authors.lastname: Santti
authors.forename: Tapani
authors.initials: T
authors.lastname: Liukkonen
authors.forename: Pekka
authors.initials: P
authors.lastname: Hellström
authors.forename: Jyrki
authors.initials: J
authors.lastname: Mäkelä
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Puolakka
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome