23-hour Discharge for Massive Rectal Adenomas Treated With Transanal Endoscopic Microsurgery

Christopher Wright, Mr, Matthew Tutton, Mr. Department of Colorectal Surgery, Colchester General Hospital

Introduction
Transanal endoscopic microsurgery (TEM) provides a local treatment for rectal tumours instead of radical surgery. Although introduced in the 1980s, little has been reported about tumour size or massive adenomas over 4cm in size in relation to early discharge. This series confirms that larger adenomas can be safely removed by TEM, without affecting the prospect of early discharge.

Method
All patients undergoing TEM procedures performed in a 3-year period between 2008-2011 were included in the study. Data was taken from a prospectively compiled database including demographics, hospital stay data and histology reports.

Results
64 patients were identified. The mean age was 64 years (range 28-87). The maximum tumour diameter was 4.6cm (+/- 0.38cm (standard error)). 36 tumours (56%) were massive adenomas and 6 were circumferential tumours. The median hospital stay was 1 day (range 1-31), with 77.3% being discharged on a 23 hour basis. There was no correlation between size of tumour and hospital stay (p=0.187 (regression analysis)). In particular there was no significant difference in the median hospital stay for tumours <4cm compared with ≥4cm (both 1 day). 6 patients had complications (7.6%) with no relation to tumour size. With a mean follow-up of 19.8 months (+/-3.2) there were 3 recurrences (4.7%), 2 in the massive adenoma group (p=0.71 (Fishers exact)).

Conclusion
TEM is an ideal method for resection of large rectal adenomas without the morbidity or radical surgery. The majority of massive rectal adenomas treated by TEM are suitable for 23 hour discharge and this does not increase the risk of complications. Whilst other local treatments report a high recurrence risk with large adenomas TEM provides a safe and effective means of treatment.
 

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