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Analysis of the therapeutic effect of transanal endoscopic microsurgery on large rectal adenoma
Yongbo Zhang1, Peng Yu2, Peng Wang3
1Department of General Surgery, The First Affiliated Hospital of Shandong, First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, The First Affiliated Hospital of Shandong, First Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, China.
Purpose:
Rectal adenoma, a pre-cancerous lesion, is one of the indications for transanal endoscopic microsurgery (TEM). TEM has its unique advantages in the treatment of rectal adenomas. However, there are few reports on the therapeutic effects of large rectal adenoma (LRA). The objective of this study was to investigate the value of TEM in the treatment of LRA.
Materials And Methods:
We collected data from patients who underwent surgery at our center from 2007 to 2017. The postoperative pathology of all patients was rectal adenoma and the diameter of the adenoma was 3 cm or greater. Moreover, all patients underwent TEM. We followed up to observe the incidence of no wound healing, rectal stenosis and recurrence rate of rectal adenoma. The risk factors of adenoma recurrence and wound healing were analysed using single- and multiple-factor analysis.
Results:
The clinicopathological data of 85 patients with LRA were collected through a pre-set table. During the follow-up period, eight patients were lost to follow-up, and three (3.90%) patients developed rectal stenosis. After 2 years of post-operative follow-up, 20 (25.97%) patients had recurrence and 57 (74.03%) patients had no recurrence. Multivariate analysis showed that positive margin was an independent risk factor for recurrence of adenoma.
Conclusions:
TEM is feasible in the treatment of large rectal tumours in Centers of Expertise with the technique.
Insights
Transanal endoscopic microsurgery (TEM) is effective for treating large rectal adenomas (LRAs), a pre-cancerous condition. While recurrence occurred in 25.97% of patients, positive margins were identified as a key risk factor.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Rectal adenoma is a pre-cancerous lesion.
- Transanal endoscopic microsurgery (TEM) offers unique advantages for rectal adenoma treatment.
- Limited reports exist on the therapeutic effects of large rectal adenoma (LRA) treatment.
Purpose of the Study:
- To investigate the therapeutic value of TEM in treating large rectal adenomas (LRAs).
Main Methods:
- Retrospective analysis of 85 patients with LRA (≥3 cm diameter) treated with TEM between 2007-2017.
- Follow-up assessed wound healing, rectal stenosis, and adenoma recurrence.
- Risk factors for recurrence and wound healing were analyzed using univariate and multivariate methods.
Main Results:
- Three patients (3.90%) developed rectal stenosis.
- After 2 years, 20 patients (25.97%) experienced recurrence, while 57 (74.03%) did not.
- Positive surgical margins were identified as an independent risk factor for adenoma recurrence.
Conclusions:
- Transanal endoscopic microsurgery (TEM) is a feasible treatment option for large rectal tumors in specialized centers.
- Careful margin assessment is crucial for minimizing recurrence risk in LRA treatment.
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