Full thickness transanal re-excision following endoscopic removal of malignant rectal polyps

Segmental resection is recommended for malignant polyps of the colon that are removed endoscopically with questionable margins. However, when such a lesion is present in the rectum, radical resection may involve a higher risk procedure such as low anterior resection or abdominoperineal resection. We report our long-term results in patients treated by transanal re-excision (TAR) following endoscopic removal of malignant rectal polyps (MRP).

Twenty-three patients were identified between 2000 and 2006 as having undergone TAR following complete gross endoscopic removal of an MRP. All lesions demonstrated close, unclear, or microscopically positive polypectomy margins.

Our population consisted of 13 men and 10 women with a median age of 61 years (range 52-86). Seventeen (74%) patients demonstrated no evidence of residual tumor. Six patients were found to have residual disease (three adenoma, two adenocarcinoma, one positive lymph node). Morbidity was minimal, and there were no mortalities. At a median follow-up of 64.6 months (range 11-90), there have been no recurrences.

We conclude that in approximately one quarter of patients, residual disease is identified following TAR. Given the relatively safety and the low recurrence rate associated with this procedure, TAR may be considered as an alternative to radical resection for MRPs with unsatisfactory margins.