Importance of Resection Margins in the Treatment of Rectal Adenomas by Transanal Endoscopic Surgery

Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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.

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Acknowledgments

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.

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Authors

Contributions

-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.

Corresponding author

Correspondence to Neus Ruiz-Edo.

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The authors declare that they have no conflict of interest.

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Cite this article

Serra-Aracil, X., Ruiz-Edo, N., Casalots-Casado, A. et al. Importance of Resection Margins in the Treatment of Rectal Adenomas by Transanal Endoscopic Surgery. J Gastrointest Surg 23, 1874–1883 (2019). https://doi.org/10.1007/s11605-018-3980-x

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Keywords

  • TEM
  • Rectal adenomas
  • Recurrence rectal adenomas
  • Follow-up rectal adenomas