Details

Autor(en) / Beteiligte

• Serra‐Aracil, X.
• Pallisera‐Lloveras, A.
• Mora‐Lopez, L.
• Serra‐Pla, S.
• Puig‐Diví, V.
• Casalots, À.
• Martínez‐Bauer, E.
• Navarro‐Soto, S.

Titel

Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins

Ist Teil von

• Colorectal disease, 2018-09, Vol.20 (9), p.789-796

Ort / Verlag

England: Wiley Subscription Services, Inc

Erscheinungsjahr

2018

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Aim To determine the percentage of residual lesion observed in the pathology study of transanal endoscopic surgery (TEM) specimens after endoscopic polypectomy of malignant rectal polyps with questionable margins, and the need for further surgery. Secondary aims: to determine the morbidity and mortality associated with this procedure and to identify the percentage of recurrence after excision by TEM. Methods Observational study with prospective data collection of all patients undergoing TEM after endoscopic polypectomy for malignant rectal polyps or non‐invasive high‐grade neoplasia, from January 2004 to December 2016. An en bloc full‐thickness wall excision of the scar was performed. Variables recorded: histology of TEM specimen, 30‐day morbidity and mortality according to the Clavien‐Dindo classification, need for salvage surgery and recurrence. Results Fifty out of 690 patients undergoing TEM during the study period (36 adenocarcinomas, five non‐invasive high‐grade neoplasias and 9 neuroendocrine tumors) were included. Post‐surgery histology showed residual lesion in 21 (42%) patients: 7 neuroendocrine tumors, 10 adenomas and 4 adenocarcinomas (two pT1, one pT2 and one pT3). The pT2 and pT3 patients (4%) underwent salvage surgery. No recurrence was observed, and mean follow‐up was 29.1Â ± 21.6 months. The 30‐day morbidity rate was 14%, but 4/7 with Clavien‐Dindo grade I. Conclusions After endoscopic polypectomy of malignant rectal polyps with questionable margins, the presence of residual lesion in the pathology study of transanal resection specimens is high. TEM with full‐thickness resection of these lesions is an appropriate treatment, allowing disease control and achieving minimal morbidity