[Surgical approach to villous tumors of the rectum]

The authors report the results of the surgical treatment of 39 villous adenomas of the rectum operated on during a 10-year period. Twenty-nine tumours were treated by a local excision, and 10 by a subtotal rectal resection. The choice for the procedure was mainly determined by the level of the lower tumour margin. Thirty-four operations were performed with a curative goal, and the 5 others for debulking. There was no operative mortality, and the morbidity was very low. Four invasive carcinomas were detected in the operative specimens and the four patients were withdrawn from the follow-up. In the "curative group", local recurrence rate was 21% after a mean follow-up period of 46 months. The tumour recurrences were small, and 2/3 among them were easily treated by reoperation (1 case) or further coagulations. With some complementary coagulations, surgery yielded a full control of 100% of the C1, 83% of the C2 and 66% of the C3 lesions. Full tumour clearance was achieved in two patients of the debulking group, with some postoperative coagulations. Our series and the literature confirm the efficiency of the surgical approach, which, moreover, allows the best histological assessment in one single session.