Recurrence after transanal endoscopic microsurgery for large rectal adenomas |
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Authors: | Marco Ettore Allaix Alberto Arezzo Paola Cassoni Federico Famiglietti Mario Morino |
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Institution: | Digestive and Colorectal Surgery and Centre for Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy. |
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Abstract: | Background Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a “tailored” approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma. Methods This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12?months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated. Results Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3?cm underwent TEM. Postoperative morbidity rate was 7.2?% (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range?=?12–216) months, 13 patients (5.6?%) were diagnosed with local recurrence. The median time to recurrence was 10 (range?=?4–33) months, with 76.9?% of recurrences detected within 12?months after TEM. At univariate analysis, tumor diameter (p?=?0.007), and positive margins (p?0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p?=?0.003). Conclusions TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence. |
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