Abstract
The goal in treatment of villous tumor of the rectum is complete excision of the tumor with preservation of the anal sphincter. Transanal endoscopic microsurgery (TEM) permits precise excision of large sessile tumors which is located 5 to 20cm from the anus. By using a operative rectoscope sealed with a gastight working insert fine visualization of a rectal tumor can be achieved. Also the manipulation of the endoscopic surgical instruments such as the high frequency knife, forceps, scissors, and suction device allows precise excision of the lesion as well as the suture of the defect of the rectal wall.
Six patients has been underwent TEM resection for the rectal villous tumors between June 1994 and August 1995. All patients were examined by endorectal ultrasound. Villous tumors ranging from 3.2 to 8.0cm in size (mean, 4.6cm) . Mucosectomy was performed in three patients and full thickness excision in other three patients. Distal extent of the tumors ranged from 5 to 12cm from the anal verge.
The operative duration ranged from 70 to 250 min (mean, 128min) . Postoperative histological diagnosis revealed 2 villotubular adenocarcinoma, 3 tubulovillous adenocarcinoma, and 1 tubulovillous adenoma. Five cases that diagnosed adenocarcinoma were intramucosal cancer and no invasion to the submucosal layer were seen. Complications were occurred as follows in 5 patients (83%) : 2 unknown fever, 3 dehiscence of the suture line, and 1 perforation. All of the patient were treated conservatively. The mean length of hospital stay was 10 days. No cases were converted to conventional method of resection.
TEM is a safe and effective method for resecting favorable tumors in select cases.
