A team from Leicester, England, conducted an audit of the results of endoscopic transanal resection of tumor (ETAR) performed by a single surgeon at a specialized colorectal unit during a 10-year period.
The surgical outcome of 104 patients (43 women) undergoing ETAR between 1989 and 1999 was reviewed.
Patients were identified from the consultant's personal records and cross-referenced with operating room logs.
Data were collected retrospectively and no patients were lost to follow-up.
The patients underwent a total of 163 procedures during the study period.
Follow-up ranged from 6 months to 10 years.
Some 75 patients with a pre-ETAR diagnosis of benign rectal adenoma underwent resection. In 60 patients, the diagnosis was confirmed to be benign; 30 of these were treated with a single resection, and 28 with multiple resections.
There were two technical failures, both a result of high mobility of the lesion.
The authors found that in no patients did carcinoma subsequently develop.
In the remaining 15 patients, the final histology demonstrated a malignancy. Of these, 9 patients underwent an open surgical rectal resection and 5 had complete endoscopic resection of their lesion.
The researchers found that no carcinomas that were fully resected endoscopically, recurred (follow-up, 13 months to 8 years).
The final patient had an extensive rectal cancer and was palliated for 2 months by ETAR.
| Rates of death and complications were low.
| Annals of Surgery |
Twelve patients (8 men) underwent ETAR for anastomotic strictures; successful treatment was achieved in 11.
The one failure was in a Park's pouch that was subsequently refashioned.
A further 17 patients underwent 30 ETARs for palliation of non-resectable rectal adenocarcinoma.
Successful palliation of symptoms was achieved in 13 patients. The remainder underwent colostomy formation.
It was found that 1 patient died of a myocardial infarction. In addition, there were 2 further complications (blood transfusion for postoperative bleeding, postoperative cerebrovascular accident).
Christopher D. Sutton, of the Leicester General Hospital, concluded on behalf of his group, "Endoscopic transanal resection of tumor is safe and effective.
"It offers successful palliation or definitive treatment of rectal lesions, with low rates of death and complications, when performed by a dedicated surgeon."