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

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.