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Updated: Nov 26, 2025

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

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Published on: February 12, 2022

Local excision after polypectomy for rectal polyp cancer: when is it worthwhile?

Helen J S Jones¹, Issam Al-Najami², Gunnar Baatrup²

¹Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland

|December 11, 2020

Summary

Further local excision after rectal cancer polypectomy is often unnecessary. Careful endoscopy is key, as residual adenoma after transanal endoscopic microsurgery (TEM) can be missed, impacting survival. Further excision is beneficial only if residual adenoma is detected.

Keywords:

local excision malignant polyp polypectomy rectal cancer

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Area of Science:

Gastroenterology
Surgical Oncology
Colorectal Surgery

Background:

Optimal management of endoscopically removed polyp cancers remains unclear.
Further local excision is frequently recommended but its benefit is uncertain.

Purpose of the Study:

To define indications for further local excision after rectal cancer polypectomy.
To evaluate the necessity of additional procedures post-polypectomy.

Main Methods:

Prospective data from two institutions (UK and Denmark) were analyzed.
Included patients who underwent transanal endoscopic microsurgery (TEM) after macroscopically complete polypectomy for rectal cancer.
Data spanned an 11-year period.

Main Results:

37% of TEM specimens showed residual adenoma after initial polypectomy.
8% experienced local recurrence, and 3% distant metastases.
Residual adenoma in TEM specimens correlated with poorer survival and higher recurrence rates.

Conclusions:

Further local excision often shows no residual cancer, even with involved margins.
Careful endoscopy is crucial for detecting missed residual tumors.
TEM may not benefit patients without residual adenoma, though a small recurrence risk persists.