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Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins.
- Source :
-
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2018 Sep; Vol. 20 (9), pp. 789-796. Date of Electronic Publication: 2018 Apr 17. - Publication Year :
- 2018
-
Abstract
- Aim: To determine the percentage of residual lesion observed in the pathology study of transanal endoscopic surgery (TEM) specimens after endoscopic polypectomy of malignant rectal polyps with questionable margins, and the need for further surgery. Secondary aims: to determine the morbidity and mortality associated with this procedure and to identify the percentage of recurrence after excision by TEM.<br />Methods: Observational study with prospective data collection of all patients undergoing TEM after endoscopic polypectomy for malignant rectal polyps or non-invasive high-grade neoplasia, from January 2004 to December 2016. An en bloc full-thickness wall excision of the scar was performed. Variables recorded: histology of TEM specimen, 30-day morbidity and mortality according to the Clavien-Dindo classification, need for salvage surgery and recurrence.<br />Results: Fifty out of 690 patients undergoing TEM during the study period (36 adenocarcinomas, five non-invasive high-grade neoplasias and 9 neuroendocrine tumors) were included. Post-surgery histology showed residual lesion in 21 (42%) patients: 7 neuroendocrine tumors, 10 adenomas and 4 adenocarcinomas (two pT1, one pT2 and one pT3). The pT2 and pT3 patients (4%) underwent salvage surgery. No recurrence was observed, and mean follow-up was 29.1Â ± 21.6 months. The 30-day morbidity rate was 14%, but 4/7 with Clavien-Dindo grade I.<br />Conclusions: After endoscopic polypectomy of malignant rectal polyps with questionable margins, the presence of residual lesion in the pathology study of transanal resection specimens is high. TEM with full-thickness resection of these lesions is an appropriate treatment, allowing disease control and achieving minimal morbidity.<br /> (Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)
- Subjects :
- Adenocarcinoma mortality
Adenocarcinoma pathology
Age Factors
Aged
Colonic Polyps mortality
Colonic Polyps pathology
Databases, Factual
Disease-Free Survival
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Invasiveness pathology
Neoplasm Recurrence, Local pathology
Neoplasm Recurrence, Local surgery
Neoplasm Staging
Patient Safety
Rectal Neoplasms mortality
Rectal Neoplasms pathology
Reoperation methods
Reoperation mortality
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis
Time Factors
Treatment Outcome
Adenocarcinoma surgery
Colonic Polyps surgery
Margins of Excision
Proctoscopy methods
Rectal Neoplasms surgery
Transanal Endoscopic Surgery methods
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1318
- Volume :
- 20
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
- Publication Type :
- Academic Journal
- Accession number :
- 29577555
- Full Text :
- https://doi.org/10.1111/codi.14108