title: Successful Resection of a Large Rectal Adenoma Using the Transsacral Approach.
abstract: The transsacral approach is not routinely used for treating rectal tumors. We report the case of a 65-year-old man with a large adenoma at the posterior wall of the mid-rectum who was treated via the transsacral approach. The same lesion had been treated using transsacral endoscopic microsurgery 8 years previously. Moreover, 11 years previously he had undergone a laparotomy for bladder cancer, and an Indiana pouch had been constructed. Abdominal computed tomography showed that the pouch was adjacent to the rectum. Therefore, the less-invasive transsacral approach, rather than the transabdominal approach, was chosen for treatment. The lesion was successfully resected, without disturbing the pouch. Histological analysis indicated tubular adenoma, with a small focus of intramucosal adenocarcinoma, and negative margins. Thus, we achieved successful resection of mid-rectal lesions via the transsacral approach, without the morbidity associated with major laparotomy. We suggest that this procedure should be a part of a surgeon's armamentarium.
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Takuya
authors.initials: T
authors.lastname: Horio
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Oka
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Ichitaro
authors.initials: I
authors.lastname: Shiratsuchi
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Saisho
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Yuutarou
authors.initials: Y
authors.lastname: Mihara
authors.affiliation: Department of Pathology, Kurume University School of Medicine.
authors.forename: Reiichirou
authors.initials: R
authors.lastname: Kondo
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Kinugusa
authors.affiliation: Department of Pathology, Kurume University School of Medicine.
authors.forename: Jun
authors.initials: J
authors.lastname: Akiba
authors.affiliation: Department of Surgery Kurume University School of Medicine.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D003113:Colonoscopy; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: early rectal cancer; large rectal adenoma; recurrence after TEM; transsacral approach