Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas

• Published in: Colorectal disease 2006-11, Vol.8 (9), p.795-799
• Main Authors: Whitehouse, P. A., Tilney, H. S., Armitage, J. N., Simson, J. N. L.
• Format: Article
• Language: English
• Subjects: Adenoma - pathology; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Anal Canal - surgery; Endoscopy - adverse effects; Endoscopy - methods; Endoscopy - mortality; Follow-Up Studies; Humans; local recurrence; Microsurgery - adverse effects; Microsurgery - methods; Microsurgery - mortality; Middle Aged; Morbidity; Neoplasm Recurrence, Local; Prospective Studies; Recovery of Function; rectal adenoma; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Risk Factors; Transanal endoscopic microsurgery
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2006.01098.x

Objective  Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasms. It is considered a safe and effective treatment but recurrence rates of 1–13% are reported for benign lesions. The aim of this study was to assess risk factors for local recurrence of benign rectal lesions and to evaluate mortality and morbidity following TEM. Method  Data were prospectively collected from all patients undergoing TEM for benign adenomas from January 1998 to March 2005. The procedure was performed by a single surgeon and patients were regularly followed up. Results  One hundred and forty‐six procedures were included, with a median patient age of 74 years (range 22–92 years). The mean lesion area was 16 cm2 (range 0.3–150 cm2) and the median distance from the dentate line was 9 cm (range 0–17 cm). Immediate complications included bleeding (six) and acute urinary retention (six). There has been one (0.68%) procedure‐related death. After a median follow up of 39 months (range 4–89 months) there have been seven recurrences (4.8%), recurring at a mean time of 23.3 months (range 5–48 months). Only microscopic involvement of the circumferential resection margin was found to be significantly associated with recurrence (P = 0.0059). Recurrence was not associated with age, size of lesion, previous treatment, severity of dysplasia or use of the harmonic scalpel. Conclusion  TEM is a safe and effective treatment for benign rectal adenomas. Circumferential resection margin involvement is associated with recurrence, which tends to occur late. Therefore extended follow up is recommended.