Treatment strategies and outcomes for rectal villous adenoma from a single-center experience

Sungeyun David Cho, Daniel O. Herzig, Miriam A. Douthit, Karen E. Deveney

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Objectives: To analyze a 13-year, single-surgeon experience with villous adenoma of the rectum with respect to procedure, complications, recurrence, and cancer incidence. Design: Retrospective review of patient and tumor characteristics, procedure, recurrence, and complications. Setting: University hospital. Patients: Patients who underwent excision of rectal villous adenoma. Main Outcome Measures: Complication, recurrence, and malignancy rates. Results: Thirty-six patients underwent 30 transanal and 10 transabdominal excisions. Mean age was 66 years (range, 41-86 years) and mean follow-up was 25 months (range, 0.5-132 months). Mean tumor size was 3.0 cm (range, 0.5-11 cm) and the mean distance of the tumor from the anal verge was 4.9 cm (range, 0-10 cm). Pre-operatively, 18 (45%) lesions harbored low-grade dys-plasia while 17 (43%) had high-grade dysplasia. Postoperative pathology was discordant in 50% of patients, including 5 of 40 lesions (13%) that were recategorized as invasive cancer. Tumor size did not correlate with malignancy. The complication rate was significantly lower in transanal compared with transabdominal excisions (3.6% vs 50%, P=.005). There were 4 (12.5%) benign recurrences, all after transanal excisions. Conclusions: Complete excision is warranted for rectal villous adenomas, as biopsies were accurate only 50% of the time, and 1 in 8 patients had unsuspected cancer found after excision. Transanal excision with negative margins is associated with low recurrence and complication rates and is the preferred approach, even with large lesions.

Original languageEnglish (US)
Pages (from-to)866-870
Number of pages5
JournalArchives of Surgery
Volume143
Issue number9
DOIs
StatePublished - Sep 1 2008

ASJC Scopus subject areas

  • Surgery

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