Treatment of early rectal tumours by transanal endoscopic microsurgery in Hong Kong: prospective study

WCS Meng, PYY Lau, AWC Yip
Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong

OBJECTIVE. To summarise the results of transanal endoscopic microsurgery for the treatment of rectal villous adenoma and early rectal tumours.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Consecutive patients between November 1995 and January 2003.

INTERVENTION. Transanal endoscopic microsurgery.

MAIN OUTCOME MEASURES. Intra-operative morbidity and mortality, complication rate, operating time, postoperative morbidity and mortality, recurrence rate and correlation between preoperative ultrasonography staging and postoperative pathological staging.

RESULTS. Thirty-two patients with rectal villous adenoma and early rectal carcinoma were registered, 31 of whom (14 men and 17 women) were included in the study. The median tumour size was 2.5 (range, 1-8) cm and the median operating time was 95 (45-220) minutes. The median follow-up period was 23 (2-92) months, and there was no local recurrence. There was no operation-related mortality and the resection margins were all clear. Complications included temporary flatus incontinence (n=2), acute retention of urine (n=1), exacerbation of chronic obstructive airway disease (n=1), and secondary haemorrhage in a patient on aspirin.

CONCLUSIONS. Transanal endoscopic microsurgery is a safe procedure and can achieve good local tumour control. It is ideal in the management of rectal villous adenomas at stages pT0 and pTis. Its application is now extended to the treatment of early rectal carcinoma at stage pT1 with curative intent. For tumours at stage pT2 or later, it can also serve as a good option for local palliation.

Hong Kong Med J 2004;10:239-43

Key words: Adenoma; Microsurgery; Proctoscopy; Rectal neoplasms; Treatment outcome