[Surgical treatment of villous tumors of the rectum]

Out of 36 villous tumours observed in 31 patients, 50 p. 100 were sessile and 1/3rd were degenerated, their degeneration was much more frequent in the case of sessile villous tumours. There were 5 biopsy errors. Out of 23 villous tumours, class A, 11 underwent local removal with two relapses, 7 recto-sigmoidal resections and 3 amputations of the rectum and 2 Hartmann operations. Out of 12 villous tumours classified as B and C, 5 underwent local removal, 4 resections, 3 palliative amputations. In all, there were 5 relapses. Tumours class C are severe and have the same prognosis as carcinoma of the rectum. Certain benign villous tumours are very difficult to remove locally owing to their broad base and their volume, which may necessitate mutilation. The present therapeutic attitude of the authors is due to the severity of relapses which may be seen late and possible biopsy errors. Broad removal is recommended for benign villous tumours which are broadly implanted and very voluminous. If the villous tumour is above the pouch of Douglas, resection is preferable to local removal. On the other hand, local removal is justified for benign villous tumours placed above the pouch of Douglas, which may be pediculated or sessile with a narrow base and with normal neighbouring mucosa.