TRANSANAL ENDOSCOPIC MICROSURGERY IN LARGE, SESSILE ADENOMAS OF THE RECTUM - A 10-YEAR EXPERIENCE

The clinical and long-term results of 286 cases encountered from 1983 to 1993 in our Department of Surgery regarding the local excision of l arge, sessile rectal adenomas (>2 cm(2)) by the endoscopic surgical me thod and the influence of this selected series of adenomas on age, sex , size, grade of dysplasia, and architecture are subjects of this stud y. Histologically proven rectal carcinomas as well as nonneoplastic po lyps were excluded from this trial. Early postoperative complications amounted to 3.4%, The 1-year and 5-year recurrence rates +/- SE of ade nomas were 1.2 +/- 0.7% and 7.0 +/- 1.9%, respectively. Remarkably, th ere was no significant relationship between the histological type of t he adenoma and the grade of dysplasia nor between the size and grade o f dysplasia. However, there was a significant relationship between the size and histological type of the adenoma (P < 0.01), With the endosc opic minimal-invasive system, we are able to achieve a superior rate o f recurrence compared to any other local treatment as well as a more f avorable operative result compared to extensive surgical procedures.