title: Treatment of preoperatively diagnosed colorectal adenomas by transanal endoscopic microsurgery: the experience in China.
abstract: BACKGROUND
  Colorectal adenoma is a recognized precancerous lesion that has the potential for malignant transformation. Surgical resection of colorectal adenomas is required for exact diagnosis and treatment. The aim of this study is to assess the safety and therapeutic effect of transanal endoscopic microsurgery for preoperatively diagnosed colorectal adenomas.
  
  
  METHODS
  From September 2006 to February 2011, 45 patients with preoperatively diagnosed colon and rectal adenomas underwent transanal endoscopic microsurgery. The clinical data of these patients were reviewed.
  
  
  RESULTS
  The mean tumor diameter was 2.2 cm, mean operative time was 65 min, and the mean estimated blood loss was less than 10 mL. There was no conversion to transabdominal procedure. The mean tumor distance from the anal verge was 8.2 cm. Four patients had perforation into the peritoneal cavity during full-thickness resection; these were repaired by continuous suturing, and there was no postoperative leakage after 1 week of fasting. The surgical margins of specimens were negative in 44 patients. Complications included rectal bleeding in one patient, acute urinary retention in one patient and pulmonary infection in one patient. The mean postoperative hospital stay was 4.5 days. Only one patient experienced incontinence of hard stool 6 months after surgery. The patients were followed up for a median period of 42 months, with four cases of tumor recurrence observed.
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery is a safe and effective technique for excising large adenomas in the mid and upper rectum and in the lower sigmoid colon. It is also an oncologically preferred method for T1 focal carcinomas that develop from villous adenomas.
authors.affiliation: Department of General Surgery, RuiJin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Han
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: He
authors.forename: Mou-Bin
authors.initials: MB
authors.lastname: Lin
authors.forename: Hao-Bo
authors.initials: HB
authors.lastname: Zhang
authors.forename: Ke-Zhi
authors.initials: KZ
authors.lastname: Lv
authors.forename: Ya-Jie
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D002681:China; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Colorectal neoplasm; preoperatively diagnosed adenoma; transanal endoscopic microsurgery