Importance of Resection Margins in the Treatment of Rectal Adenomas by Transanal Endoscopic Surgery
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Polypectomy is the gold standard for treating colorectal adenomas up to 2 cm in size. For larger lesions, various procedures ranging from endoscopy to transanal surgery can be performed and achieve varying results for en bloc resection and recurrence. There are no clear guidelines for dealing with involved resection margins. We assess the recurrence of rectal adenomas operated using TEM with full-thickness wall excision with or without free resection margins and define optimal endoscopic follow-up.
Observational study with prospective data collection, including patients undergoing TEM between 6/2004 and 11/2017, with definitive diagnosis of rectal adenoma. Data on epidemiological, preoperative, surgical, postoperative, pathological, and follow-up variables were recorded. Univariate analysis, follow-up risk function, and multivariate logistic regression analysis were performed to detect risk factors for recurrence.
TEM was indicated in 736 patients; 481 adenomas were identified in the preoperative biopsy, of which 95 were infiltrating adenocarcinomas (19.8%) in the definitive pathology study. With a minimum follow-up of 1 year, 372 patients were included. Pathology study showed free margins in 324 (87%). Recurrences were recorded in 15 patients (4%), up to 18 months in the free margins group and up to 24 months in the involved margins group. Thirteen patients with recurrence (86.6%) were treated with TEM. No predictors of recurrence were found in the multivariate analysis.
TEM is the technique of choice for treating rectal adenomas and recurrences, achieving a low relapse rate. Follow-up must be adapted to resection margins and should be extended to 24 months.
KeywordsTEM Rectal adenomas Recurrence rectal adenomas Follow-up rectal adenomas
The study has not been presented previously in any form. All the authors contributed to the design and writing of the paper.
We thank the rest of the members of the Coloproctology Unit in the General Surgery Department and all the members of the Multidisciplinary Team in Colorectal Cancer for their help in applying the study protocol. We thank Cristina Gomez Vigo for correcting the manuscript and Michael Maudsley for his help with the English.
-Study conception and design: Serra-Aracil, Mora-Lopez, Ruiz-Edo.
-Acquisition of data: Serra-Aracil, Ruiz-Edo, Casalots-Casado, Mora-Lopez, Pallisera-Llobera, Serra-Pla, Puig-Diví, Navarro-Soto.
-Analysis and interpretation of data: Serra-Aracil, Ruiz-Edo, Casalots-Casado, Mora-Lopez, Pallisera-Llobera, Serra-Pla, Puig-Diví, Navarro-Soto.
-Drafting of manuscript: Serra-Aracil, Ruiz-Edo, Casalots-Casado, Mora-Lopez, Pallisera-Llobera, Serra-Pla, Puig-Diví, Navarro-Soto.
-Critical revision: Serra-Aracil, Ruiz-Edo, Casalots-Casado, Mora-Lopez, Pallisera-Llobera, Serra-Pla, Puig-Diví, Navarro-Soto.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 10.Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134:1570–-95.CrossRefGoogle Scholar
- 16.Serra-Aracil X, Gálvez A, Mora-López L, Rebasa P, Serra-Pla S, Pallisera-Lloveras A, et al. Endorectal ultrasound in the identification of rectal tumors for transanal endoscopic surgery: factors influencing its accuracy. Surg Endosc 2017 Dec 21. doi: https://doi.org/10.1007/s00464-017-5988-9.CrossRefGoogle Scholar
- 20.Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag H-J, Messmann. H, et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2017;gutjnl-2016-313677.Google Scholar
- 27.Barendse RM, Musters GD, de Graaf EJR, van den Broek FJC, Consten ECJ, Doornebosch PG, et al. Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study). Gut 2017;gutjnl-2016-313101.Google Scholar