Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis

Abstract

INTRODUCTIONColorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required.PRESENTATION OF CASEThe case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14 cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free.DISCUSSIONRemoval of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer.CONCLUSIONEversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.

Resección de adenoma velloso gigante causante del síndrome de Mckittrick-Wheelock

“…En estos casos, los tumores se extirparon quirúrgicamente. 15,16 No existe un punto de corte claro en cuanto al tamaño del tumor para definir cuáles son pasibles de tratamiento endoscópico.…”

Giant villous adenoma of rectum- what is the malignant potential and what is the optimal treatment? A case and review of literature

“…24 cm 2 3. 5–14 cm or 99 cm 2 -Villous adenoma-Villous adenoma with high-grade dysplasia and intramucosal carcinoma-Villous adenoma with low-grade dysplasia4.Agnes A, Novelli D et al [15]9 cmVillous adenoma with areas of intramucosal adenocarcinoma and high-grade dysplasia5.Challis BG, Lim CT et al [16]10 cmTubulovillous adenoma exhibiting moderate to low-grade dysplasia6.Okano M, Okuyama M et al [17]10 cm7.Mois EI, Graur F et al [18]14 cmLow-grade dysplasia with focal high-grade dysplasia8.Nakhla SG, Murakami TT et al [19]17 cmLarge rectal villous adenoma coexistent with a poorly differentiated neuroendocrine tumor of the rectum9.Kure K, Kawai M et al [20]12.7 × 11.5 cmMostly tubulovillous adenoma, but partially moderately differentiated adenocarcinoma.10.Das P, Vijay MK et al [21]8.5 × 6 × 4 cmGiant villous adenoma with low-grade dysplasia11.Ohtsuka M, Hata T et al [22]Concurrent adenocarcinoma12.Roriz-Silva R, Andrade AA et al [23]14 cmVillous adenoma with low-grade atypia13.Aboul Hosn M, Abdel-Hafiez N et al [24]12 cmNo evidence of invasive carcinoma14.Barendse RM, van den Brandt S et al [25]9 cmVillous adenoma with focal high-grade dysplasia15.Choi WH, Ryuk J et al [26]25 cm × 12 cmWell-differentiated adenocarcinomas arising in villotubular adenomas16.Tuţă LA, Boşoteanu M et al [27]12 × 10 cmWell-differentiated adenocarcinoma arising within a villous adenoma.17.Dagan A and Reissman P [28]. 31 cmLow- to high-grade dysplasia18.Cubuk R, Tasali N et al [29]17 × 9 cmVillous adenoma without high-grade dysplasia19.Koning GG, Rensma PL et al [30]15 × 8Low-grade dysplasia20.Nagri S, Eskaros S et al [31]8 × 5 × 4 cmGiant villous adenoma with high-grade dysplasi...…”

“…A recent study found that the incidence of cancer in patients undergoing colectomy for an irretrievable polyp is 17.7% [39]. Open or laparoscopic colorectal resection is the procedure of choice for lesions not eligible for endoscopic resection and for large sessile villous tumors [4, 23, 26, 39]. It has been demonstrated a mortality rate of 0.3% with an anastomotic leak rate of 1.4% [4, 11, 39].…”

Gigantinė Tiesiosios Žarnos Adenoma. Klinikinis Atvejis

“…Nėra klaida ir cirkuliarų viliozinį polipą traktuoti kaip galimai invazyvią karcinomą ir atlikti radikalią rezekcinę operaciją -net jei histologinis tyrimas nerodo piktybiškumo požymių. Kaip minėta, tikimybė, kad gigantiniame vilioziniame polipe gali būti invazyvios adenokarcinomos židinys, siekia 50 proc., todėl dalis autorių [11,12] rekomenduoja atlikti radikalią rezekciją pagal onkologinius principus. Idealu būtų piktybiškumą patikslinti dar iki operacijos, deja, jei biopsija invazijos nepatvirtina, vaizdinė diagnostika − magnetinio rezonanso tomografija (MRT) bei endoskopinis ultragarsinis tyrimas (EUG) nėra itin naudingi.…”