Indications and results of mucosal proctectomy with cole-anal anastomosis for villous disease of the rectum.

The objective of this study was to define the indication for proctectomy an d coloanal anastomosis in large rectal villous adenomas. The study populati on consisted of 20 patients (12 men and 8 women; mean age 63.6) who underwe nt rectal excision and coloanal anastomosis from 1990 to 1997. The average size of tumors was 59.8 mm; 18 tumors were located in the lower third of th e rectal ampulla; 8 patients had prior treatment (surgical or medical) befo re proctectomy. There were 13 straight coloanal anastomoses and 7 construct ed with colonic J pouch. Eighty percent of the anastomoses were defunctione d by a temporary stoma. The overall morbidity included one case of pelvic s epsis, two anastomotic strictures and one colonic trans-anal prolapse. One patient experienced persistent mild fecal incontinence and two others devel oped urogenital. The mean hospital stay was 14.4 days and 8.5 days for stom a closure. 8 tumors contained malignancy: 3 Tis, 4 T1 and 1 T2. In our opin ion the extension, natural history or potential of occult malignancy of lar ge rectal villous adenomas may requires rectal excision with coloanal anast omosis with low morbidity and good functional results.