Transanal endoscopic microsurgery for the elderly patients with colorectal adenoma / 中华老年医学杂志

ABSTRACT

Objective To investigate the clinical value of transanal endoscopic microsurgery (TEM) for the treatment of elderly patients with colorectal adenoma.Methods Totally 21 patients with colorectal villous adenoma underwent TEM from Dec.2007 to Sep.2010.The distance of adenoma from the anal verge was 4-20 cm (average 8.9 cm) and tumor size was 1.1-3.5 cm (average 1.9 cm).There were 12 cases with tubular adenoma and 9 cases with villous adenoma according to pre-operative diagnosis by colonoscopy and endoanal ultrasonography (EUS).Appropriate position and posture were dictated by the location of the tumor under general anesthesia.A special rectoscopy was inserted into the anus with CO2 insufflation to keep the rectum open.Under the stereoscopy and lapaoscopy-type instruments,the tumor was completely resected (submucosal or full-thickness excision) using a 5 mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The tumor was completely removed with negative resection margins in all the 21 patients (submucosal excision in 12 cases and full-thickness excision in 9 cases).The operating time was 40-100 min (average 76 min) and the intraoperative blood loss was 10-80 ml (average 50 ml).The post-operative stay was 2-10 d (average 4.5 d).The postoperative pathological stages were pT0 in 16 cases and pTia in 5 cases.The postoperative pathological diagnosis were tubular adenoma in 12 cases,villous adenoma in 9 cases,low-grade intraepithelial neoplasia (IN) in 5 cases and high-grade IN in 5 cases.Follow-up checkups in the 20 patients for 2-20 months (average 11 months) revealed no local recurrence.Conclusions TEM is safe and effective with little complication for the treatment of elderly patients with colorectal adenoma.Pre-operative EUS is very important for TEM.