Complex rectal polyps: other treatment modalities required when offering a transanal endoscopic microsurgery service

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Oncology

Background:

• Complex rectal polyps pose significant clinical challenges.
• Management requires careful consideration of various treatment modalities.

Purpose of the Study:

• To evaluate the different treatment strategies employed for patients referred for transanal endoscopic microsurgery (TEMS).
• To assess the suitability of TEMS and identify alternative management options for complex rectal polyps.

Main Methods:

• Prospective data collection of patients referred for TEMS between 1998 and 2008.
• Analysis of referral patterns, histology, surgical procedures, and patient outcomes.
• Review of treatment modalities including TEMS, snare polypectomy, transanal excision, and anterior resection.

Main Results:

• Out of 209 referred patients, 132 (63%) were suitable for TEMS.
• 37% of patients referred for TEMS required alternative treatments, including anterior resection or snare polypectomy.
• 17 patients required staged procedures, and 3 underwent anterior resection during the index surgery.

Conclusions:

• While TEMS is suitable for many complex rectal polyps, a substantial percentage necessitates varied management approaches.
• Surgical units offering TEMS must be equipped to handle diverse pathologies and employ a range of treatment options.
• Preparedness for diverse pathology is crucial for effective management of complex rectal polyps.