Local Excision of Large Rectal Villous Adenomas

Pigot, F.; Bouchard, D.; Mortaji, Majid; Castinel, A.; Juguet, F.; Chaume, Jean-Claude; Faivre, J

doi:10.1007/s10350-004-6748-1

Cited by 51 publications

(42 citation statements)

References 20 publications

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“…Many authors tend to present the method they use as the most adequate in all types of polyp. Actually the similar satisfactory results obtained in large series of polyps including high (>10 cm from the anal verge) and large (>10 cm in diameter) lesions by experienced surgeons who adopted different techniques suggest that the operator is possibly the most important variable for a successful excision of a polyp [16,17].…”

Section: Introductionsupporting

confidence: 53%

“…A recent publication [16] on the long-term results of this technique (30% of the polyps were 8-12 cm from the anal margin and 68% had a diameter larger than 4 cm) reports a recurrence rate of adenomas of 2% and 1.5% of carcinomas with a complication rate similar to the one of the classic Parks' approach. In the experience of another of the authors (DS), with 42 polyps treated (4-12 cm from the anal margin, diameter 1.5-6 cm) by this technique (28 benign lesions, 3 Tis, 11 T1), the results were comparable to the ones reported above (6% complication rate, 4% recurrent adenoma, 2.3% appearance of carcinoma).…”

Section: Transanal Approachmentioning

confidence: 90%

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Local excision of rectal polyp: indications and techniques

Fucini

Segre²,

Trompetto³

2004

Tech Coloproctol

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The local excision of a rectal polyp is often wrongly considered to be a minor surgical procedure. In reality, the malignant potential of adenomas and the not-infrequent presence of cancer in larger polyps, require, for their removal, an oncologically correct operation with strict indication and accurate execution. Despite an increasing inclination to extend the indications of endoscopic polypectomies to polyps of larger size and villous configuration, the local surgical approach remains the preferred treatment in most cases. Here the indications and the results of different surgical techniques proposed for the local excision of a rectal polyp are reported. Among these procedures, transanal endoscopic microsurgery is gaining a primary role in many circumstances.

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Section: Introductionsupporting

confidence: 53%

Section: Transanal Approachmentioning

confidence: 90%

Local excision of rectal polyp: indications and techniques

Fucini

Segre²,

Trompetto³

2004

Tech Coloproctol

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“…In a long series of 117 procedures, Sakamoto et al [7] treated 27% of patients for residual disease and 30% for recurrence, with a 10% rate of serious complications. In a recent study, Pigot et al [8] obtained better results: they resected apparently benign rectal adenomas from 207 consecutive patients with a 3.6% recurrence rate, eight postoperative complications, and one death. Specific recurrence-free probability was 99.5% at 1 year, 96% at 5 years, and 95% at 10 years.…”

Section: Tementioning

confidence: 99%

Surgical resection of rectal adenoma: A rapid review

Casadesús¹

2009

WJG

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Transanal excision (TE), endoscopic transanal resection (ETAR) and transanal endoscopic microsurgery (TEM) can be used to remove adenomatous polyps. However, their use is limited by the size or location of the tumor. TE is limited to the lower rectum, TEM offers better access to lesions in the middle and upper rectum, and ETAR is used less frequently than it deserves for resection of rectal lesions.

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“…The main decision is whether the adenoma can be removed by local resection and, if so, by which technique. The options include an endoscopic piecemeal snare resection [7, 8], an open transanal resection (Parks) [4, 9, 10], a posterior parasacral resection (Mason) [11, 12], a posterior transsacral resection (Kraske) [13], or a transanal endoscopic microsurgical resection [14, 15]. The choice of the procedure may be influenced by preoperative staging and histological features.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Large Sessile Villous and Tubulovillous Adenomas of the Lower Rectum

Renzulli¹,

Maurer

Netzer

et al. 2004

Dig Surg

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Background: Large sessile adenomas of the rectum are premalignant lesions necessitating complete removal. Methods: We reviewed the data on 20 consecutive patients with large (≧2 cm) sessile villous and tubulovillous adenomas of the lower two thirds of the rectum (≤11 cm from the anal verge). Median (range) adenoma diameter and distance from the anal verge were 5 (2–8) and 7 (4–11) cm, respectively. All 11 patients with an adenomatous circumferential involvement of ≧50% or an endosonographic staging of ≧uT2 underwent a low anterior resection of the rectum. The remaining 9 patients underwent a posterior full-thickness local bowel wall resection (modified Mason procedure). The median (range) follow-up period was 3.8 (0.7–8.2) years. Results: Preoperative biopsy examination successfully excluded invasive carcinoma. Overstaging, however, occurred in 9 of 12 patients (75%) undergoing endosonography, resulting in surgical overtreatment of 4 patients. A curative resection (R0) was always achieved. Five patients had complications, but there was no in-hospital mortality and no cases of local recurrence. 4 out of 19 patients complained of minor stool incontinence, and 3 patients reported incomplete rectal emptying or constipation. Fourteen patients described the operative result as excellent (n = 7) or good (n = 7). Conclusions: Endosonography may lead to overstaging and overtreatment. An individualized approach based on the degree of adenomatous circumferential involvement and endosonographic staging showed no mortality, low morbidity, no local recurrence, and good functional medium-term results.

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Local Excision of Large Rectal Villous Adenomas

Cited by 51 publications

References 20 publications

Local excision of rectal polyp: indications and techniques

Local excision of rectal polyp: indications and techniques

Surgical resection of rectal adenoma: A rapid review

Surgical Management of Large Sessile Villous and Tubulovillous Adenomas of the Lower Rectum

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