[Surgical treatment of villous tumors of the rectum].

Between 1971 and 1986, 52 villous tumors of the rectum were surgically treated, which represents 8 p. cent of recto-colic tumors. The mean patient's age was 65 years. There were sessile tumors in 69 p. cent of the cases, pedunculated in 17 p. cent and flowing tumors in 12 p. cent. The mean tumor size was 3 cm. They were associated with a colon cancer in 15 p. cent of the cases, and a polyadenoma in 10 p. cent. They were located on the rectum from 0 to 6 cm in half of the cases. In one case, the tumor extended to the entire rectum. These tumors were treated in 37 cases by local excision and in 15 cases by wide excision. Three patients were re-operated upon for an extended excision. The malignant potential of the tumors was 30 p. cent including 10 p. cent of invasive malignancy. There were no surgical fatalities, but 6 p. cent of medical fatalities. There were 20 p. cent complications related to the surgical technique. 10 patients were lost to follow-up. In 42 villous tumors followed with a mean survival of 6.5 years, there were 12 recurrences: 9 underwent endoscopic excisions and in 3 cases a wide resection: Babcock, Duhamel, amputation. The various technique of tumor resection as well as operative indications of variable difficulty are presented. It seems, at present, that a total resection of the rectum with colo-anal anastomosis represents the best treatment for large flowing villous tumors extending almost though the entire rectum.(ABSTRACT TRUNCATED AT 250 WORDS)