Transanal Endoscopic Surgery With Total Wall Excision Is Required With Rectal Adenomas due to the High Frequency of Adenocarcinoma

Abstract

In this sample, half of the adenocarcinomas from adenomas were T1 adenocarcinomas. Because a high proportion of rectal adenomas are, in fact, invasive adenocarcinomas, full-thickness excision is appropriate.

Submucosal dissection has advantages over full‐thickness transanal endoscopic microsurgery in selected rectal lesions

“…These results are congruent with other published case series that have been reviewed recently . An increasing focus is on the incidental finding of occult adenocarcinomas in presumed benign lesions, which range from 2.6% to as high as 18.8% . This study reports within this range (12.2%).…”

“…With respect to the treatment of benign adenomatous lesions, some controversy exists whether to perform a submucosal or full‐thickness TEM excision. Proponents quote the incidence of unrecognized malignancy as justification for full‐thickness excision in all cases thought pre‐operatively to be benign, but it seems likely that this is associated with a longer hospital stay and complication rate when compared with submucosal excision …”

Transanal Endoscopic Surgery for Rectal Cancer

“…Early detection and removal are the best means of avoiding the development of adenocarcinoma [ 16 ]. In our series [ 17 ], and in the study by Absar and Haboubi [ 18 ], more than 18 % of patients diagnosed with adenomatous polyps were ultimately found to have invasive adenocarcinoma after surgical excision. For this reason, a piecemeal endoscopic resection or less than a full-thickness transanal excision is considered insuffi cient treatment for patients with large rectal villous adenomas.…”

“…In the case of large rectal adenomas we advocate full-thickness rectal wall resection using TEM/TEO, leaving adequate safety margins for correct staging by the pathologist [ 19 ]. In our series [ 17 ], half of the infi ltrating adenocarcinomas resulting from adenomas were pT1 lesions. This means that with adequate resection and in the absence of unfavorable histological features (high grade or lymphovascular or perineural invasion), these patients will not require additional radical surgery [ 14 , 20 , 21 ].…”

Completion proctectomy following transanal endoscopic microsurgery for early rectal cancer

“…However, understaging is not uncommon [9,[21][22][23][24][25] . Furthermore, unexpected malignancy is reported in 18%-43% of preoperatively assumed benign lesions in the rectum [9,[26][27][28] .…”