Xavier Serra-Aracil1, Neus Ruiz-Edo2, Alex Casalots-Casado3, Laura Mora-López1, Anna Pallisera-Lloveras1, Sheila Serra-Pla1, Vanlentí Puig-Diví4, Salvador Navarro-Soto1. 1. Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain. 2. Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain. mnruiz@tauli.cat. 3. Department of Pathology, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain. 4. Department of Gastrointestinal Endoscopy, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain.
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.
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.
Entities:
Keywords:
Follow-up rectal adenomas; Rectal adenomas; Recurrence rectal adenomas; TEM
Authors: Bernard Levin; David A Lieberman; Beth McFarland; Kimberly S Andrews; Durado Brooks; John Bond; Chiranjeev Dash; Francis M Giardiello; Seth Glick; David Johnson; C Daniel Johnson; Theodore R Levin; Perry J Pickhardt; Douglas K Rex; Robert A Smith; Alan Thorson; Sidney J Winawer Journal: Gastroenterology Date: 2008-02-08 Impact factor: 22.682
Authors: X Serra-Aracil; R Flores-Clotet; L Mora-López; A Pallisera-Lloveras; S Serra-Pla; S Navarro-Soto Journal: Tech Coloproctol Date: 2019-08-28 Impact factor: 3.781