Surgical resection of villous adenomas of the rectum.

Although villous lesions comprise only about 5 per cent of all adenomas, 40 per cent are premalignant. Complete colonic evaluation and resection of all villous lesions should be performed. The purpose of this study is to examine our experience with transanal excision and low anterior resection as treatment options for large villous adenomas of the rectum. A retrospective review of all cases of villous adenomas of the rectum at this institution from January 1991 to February 1997 was performed. A total of 16 patients were identified; fourteen underwent transanal excision and two underwent low anterior resection. The average lesion size was 5 cm, and 50 per cent extended proximal to 8 cm from the anal verge. Thirty-seven per cent (six patients) had villous lesions containing adenocarcinoma. Thirty-one per cent (five patients) have required treatment for residual disease noted within 6 months of resection. Twelve per cent (two patients) have received treatment for recurrent disease presenting 6 months after resection. The minor complications included two episodes of urinary retention. The serious complications included one perforation and one postoperative hemorrhage for a 12 per cent complication rate. In summary, large villous adenomas of the rectum can be removed by sphincter-preserving techniques with low morbidity and an acceptable recurrence rate.