SESSILE ADENOMAS OF THE RECTUM: A PERSONAL SERIES 1974‐1984

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Abstract
Sessile (villous) tumours of the rectum are uncommon and individual surgeons are unlikely to have wide experience in their management. A study was made of a unique personal series (AMC) of 104 cases encountered from 1974 to 1984; minimum duration of follow-up was 5 years. Clinically obvious rectal cancers were excluded from the study. Ages ranged from 42 to 89 years (mean 64.9 years) with a male: female ratio of 1.5:1. The comonest clinical presentations of sessile tumours of the rectum were rectal bleeding (45%) and altered bowel habit (38%). Hypokalaemia was a very uncommon presenting symptom (1%). These tumours ranged in longitudinal diameter from 1 to 9 cm, with 66% of cases > 3 cm and 33% of cases > 5 cm. The incidence of malignancy in sessile adenomas > 3 cm (27%) was more than triple that of adenomas < 3 cm (8%) and the presence of induration on rectal examination was the most reliable clinical indicator of the presence of malignancy. Local transanal diathermy excision was a satisfactory form of treatment for most sessile tumours of the rectum (benign and malignant), especially if they were < 3 cm (0% recurrence rate). It had the added advantage of preserving the anal sphincter and was possible in a higher proportion of sessile tumours in the lower half of the rectum (89%) than those in the upper half of the rectum (42%). The overall recurrence rate after local transanal excision was 8% for benign sessile adenomas and 33% for those containing invasive carcinoma. Recurrent tumours were treated by resection (6 of 9 tumours) or further local excision (3 of 9 tumours) depending on the general condition of the patients and the histology. This approach produced results which compared favourably with cases treated by resection as the initial procedure, either because of its site in the upper half of the rectum or because of its extremely large size (> 5 cm). In addition, a 5-year follow-up appears to be adequate for patients with sessile tumours of the rectum as all recurrences occurred within this period.