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.
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References
Risio M (2010) The natural history of adenomas. Best Pract Res Clin Gastroenterol 24:271–280
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Steward ET, The National Polyp Study Workgroup (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981
Casadesus D (2009) Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 15:3851–3854
Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284
Sutton CD, Marshall L-J, White SA, Flint N, Berry DP, Kelly MJ (2002) Ten-year experience of endoscopic transanal resection. Ann Surg 235:355–362
Tsai JA, Hedlund M, Sjoqvist U, Lindforss U, Torkvist L, Furstenberg S (2006) Experience of endoscopic transanal resections with a urologic resectoscope in 131 patients. Dis Colon Rectum 49:228–232
Barendse RM, van den Broek FJC, Dekker E, Bemelman WA, de Graaf EJR, Fockens P et al (2011) Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy 43:941–949
Dias AR, Nahas CSR, Marques CFS, Nahas SC, Cecconello I (2009) Transanal endoscopic microsurgery: indications, results and controversies. Tech Coloproctol 13:105–111
Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume J-C, Faivre J (2003) Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 46:1345–1350
Beattie GC, Paul I, Calvert CH (2005) Endoscopic transanal resection of rectal tumours using a urological resectoscope–still has a role in selected patients. Colorectal Dis 7:47–50
Shaikh S, Nabi G, O’Kelly T, Swami SK (2007) Endoscopic trans-anal resection of rectal tumours: critical appraisal of an interdisciplinary approach. Colorectal Disease 9:235–237
Bujanda L, Pereira T, Ramos F, Pérez-Ortega A, Sánchez A, Gil-Molet A, Munoz C, Echenique-Elizondo M (2005) Transanal resection of complicated rectal polyps using the urological resectoscope. Kirurgia 1:3
Tuech J-J, Pessaux P, Regenet N, Ziani M, Ollier J-C, Arnaud J-P (2004) Endoscopic transanal resection using the urological resectoscope in the management of patients with rectal villous adenomas. Int J Colorectal Dis 19:569–573
Wetherall AP, Williams NM, Kelly MJ (1993) Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer. Br J Surg 80:788–793
Modarai B, Forshaw MJ, Sankararajah D, Murali K, Stewart M (2009) Endoscopic transanal resection of rectal adenomas using the urological resectoscope. Colorectal Dis 11:859–865
Berry AR, Souter RG, Campbell WB, Mortensen NJ, Kettlewell MG (1990) Endoscopic transanal resection of rectal tumours–a preliminary report of its use. Br J Surg 77:134–137
Dickinson AJ, Savage AP, Mortensen NJ, Kettlewell MG (1993) Long-term survival after endoscopic transanal resection of rectal tumours. Br J Surg 80:1401–1404
Kockelbergh RC, Nash JR (1992) The transanal resectoscope: an under-used instrument? Aust N Z J Surg 62:809–812
Acknowledgments
The authors thank Anna Kattan for narration of the supplementary video.
Disclosures
Drs. Sallinen, Santti, Liukkonen, Hellström, Mäkelä, Puolakka, and Paajanen have no conflict of interest or financial ties to disclose. This study was funded by governmental competitive research funds (EVO) of South Karelia Central Hospital.
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464_2013_2885_MOESM1_ESM.mov
Supplementary video. Endoscopic transanal resection (ETAR) for rectal adenoma in a female patient. A case demonstration. Surgeon: Veli-Matti Puolakka. Narration: Anna Kattan. Edited: Ville Sallinen (MOV 14761 kb)
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Sallinen, V., Santti, H., Liukkonen, T. et al. Safety and long-term results of endoscopic transanal resection in treating rectal adenomas: 15 years’ experience. Surg Endosc 27, 3431–3436 (2013). https://doi.org/10.1007/s00464-013-2885-8
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DOI: https://doi.org/10.1007/s00464-013-2885-8