Transanal endoscopic microsurgery for giant polyps of the rectum

TY - JOUR

T1 - Transanal endoscopic microsurgery for giant polyps of the rectum

AU - Levic, K

AU - Bulut, O

AU - Hesselfeldt, P

PY - 2014/6

Y1 - 2014/6

N2 - BACKGROUND: The potential for malignancy in rectal polyps increases with the size of the polyp, and unexpected malignancy is reported in up to 39 % of large rectal adenomas. Transanal endoscopic microsurgery (TEM) offers the possibility of an en bloc full-thickness excision for lesions in the rectum. We present our results with TEM in the removal of giant polyps equal or greater than 4 cm in diameter.METHODS: In the period between 1998 and 2012, TEM was performed in 39 patients with rectal polyps measuring at least 4 cm in diameter. Transrectal ultrasound and/or magnetic resonance imaging of the rectum was used when cancer was suspected.RESULTS: The polyp was removed with en bloc full-thickness excision in 77 % (n = 30). The preoperative diagnosis was benign rectal adenoma in 89.7 % (n = 35). The median size of the polyps was 30 cm(2) (range 16-100 cm(2)). Postoperative complications included bleeding in 4 patients (10.3 %). Histological examination showed unexpected cancer in 4 patients (10.3 %). TEM was curative in 2 of these patients, and the other 2 underwent further surgery. Recurrences occurred in 10 patients (25.6 %) and consisted of 5 adenomas and 5 adenocarcinomas. In 5 patients, these recurrences were treated with endoscopic removal or re-TEM. The remaining 5 underwent total mesorectal excision and/or chemotherapy.CONCLUSIONS: Full-thickness TEM provides a safe and efficient treatment for excision of giant polyps. In case of unexpected cancer, TEM can be curative. Local recurrence can be often treated with a second TEM procedure.

AB - BACKGROUND: The potential for malignancy in rectal polyps increases with the size of the polyp, and unexpected malignancy is reported in up to 39 % of large rectal adenomas. Transanal endoscopic microsurgery (TEM) offers the possibility of an en bloc full-thickness excision for lesions in the rectum. We present our results with TEM in the removal of giant polyps equal or greater than 4 cm in diameter.METHODS: In the period between 1998 and 2012, TEM was performed in 39 patients with rectal polyps measuring at least 4 cm in diameter. Transrectal ultrasound and/or magnetic resonance imaging of the rectum was used when cancer was suspected.RESULTS: The polyp was removed with en bloc full-thickness excision in 77 % (n = 30). The preoperative diagnosis was benign rectal adenoma in 89.7 % (n = 35). The median size of the polyps was 30 cm(2) (range 16-100 cm(2)). Postoperative complications included bleeding in 4 patients (10.3 %). Histological examination showed unexpected cancer in 4 patients (10.3 %). TEM was curative in 2 of these patients, and the other 2 underwent further surgery. Recurrences occurred in 10 patients (25.6 %) and consisted of 5 adenomas and 5 adenocarcinomas. In 5 patients, these recurrences were treated with endoscopic removal or re-TEM. The remaining 5 underwent total mesorectal excision and/or chemotherapy.CONCLUSIONS: Full-thickness TEM provides a safe and efficient treatment for excision of giant polyps. In case of unexpected cancer, TEM can be curative. Local recurrence can be often treated with a second TEM procedure.

KW - Adenocarcinoma

KW - Adenoma

KW - Aged

KW - Aged, 80 and over

KW - Biopsy

KW - Colonoscopy

KW - Endoscopy, Gastrointestinal

KW - Endosonography

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Microsurgery

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Polyps

KW - Rectal Neoplasms

KW - Retrospective Studies

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

U2 - 10.1007/s10151-013-1069-9

DO - 10.1007/s10151-013-1069-9

M3 - Journal article

C2 - 24057356

SN - 1123-6337

VL - 18

SP - 521

EP - 527

JO - Techniques in Coloproctology

JF - Techniques in Coloproctology

IS - 6

ER -