Sequential endoscopic and surgical removal of giant rectal adenomas extending to the dentate line

Excerpt

Large tubulovillous adenomas (TVA) in the low rectum that extend to or beyond the dentate line are a rare but challenging entity. Complete endoscopic resection is often not feasible. In this situation, abdominoperineal resection with end colostomy is the classic alternative to achieve an oncologically safe resection. For benign disease however, this represents an operation with a major long-term impact on quality of life. In this report, we propose a hybrid technique using endoscopic submucosal dissection (ESD) of the lower part of the tumor in the rectum followed by low anterior resection with total mesorectal excision (LAR/TME) and primary anastomosis. This approach allowed for complete resection of large TVAs with high oncological safety in three patients. …