Article ; Online: Treatment strategies and outcomes for rectal villous adenoma from a single-center experience.
Archives of surgery (Chicago, Ill. : 1960)
2008 Volume 143, Issue 9, Page(s) 866–70; discussion 871–2
Abstract: Objectives: To analyze a 13-year, single-surgeon experience with villous adenoma of the rectum with respect to procedure, complications, recurrence, and cancer incidence.: Design: Retrospective review of patient and tumor characteristics, procedure, ... ...
| Abstract | Objectives: To analyze a 13-year, single-surgeon experience with villous adenoma of the rectum with respect to procedure, complications, recurrence, and cancer incidence. Design: Retrospective review of patient and tumor characteristics, procedure, recurrence, and complications. Setting: University hospital. Patients: Patients who underwent excision of rectal villous adenoma. Main outcome measures: Complication, recurrence, and malignancy rates. Results: Thirty-six patients underwent 30 transanal and 10 transabdominal excisions. Mean age was 66 years (range, 41-86 years) and mean follow-up was 25 months (range, 0.5-132 months). Mean tumor size was 3.0 cm (range, 0.5-11 cm) and the mean distance of the tumor from the anal verge was 4.9 cm (range, 0-10 cm). Preoperatively, 18 (45%) lesions harbored low-grade dysplasia while 17 (43%) had high-grade dysplasia. Postoperative pathology was discordant in 50% of patients, including 5 of 40 lesions (13%) that were recategorized as invasive cancer. Tumor size did not correlate with malignancy. The complication rate was significantly lower in transanal compared with transabdominal excisions (3.6% vs 50%, P = .005). There were 4 (12.5%) benign recurrences, all after transanal excisions. Conclusions: Complete excision is warranted for rectal villous adenomas, as biopsies were accurate only 50% of the time, and 1 in 8 patients had unsuspected cancer found after excision. Transanal excision with negative margins is associated with low recurrence and complication rates and is the preferred approach, even with large lesions. |
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| MeSH term(s) | Adenoma, Villous/diagnostic imaging ; Adenoma, Villous/epidemiology ; Adenoma, Villous/pathology ; Adenoma, Villous/surgery ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/epidemiology ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Retrospective Studies | |||||
| Language | English | |||||
| Publishing date | 2008-09 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article | |||||
| ZDB-ID | 80055-7 | |||||
| ISSN | 1538-3644 ; 0004-0010 ; 0096-6908 ; 0272-5533 | |||||
| ISSN (online) | 1538-3644 | |||||
| ISSN | 0004-0010 ; 0096-6908 ; 0272-5533 | |||||
| DOI | 10.1001/archsurg.143.9.866 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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