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Clin Colon Rectal Surg 2002; 15(2): 145-156
DOI: 10.1055/s-2002-32063
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Rectal Villous Adenomas

Charles B. Whitlow
  • Central Texas Colorectal and General Surgery Center, Waco, TX
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Publication History

Publication Date:
06 June 2002 (online)

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ABSTRACT

Villous tumors of the rectum account for 40 to 90% of all large bowel villous adenomas. Although increasing size is associated with risk of malignancy, villous tumors can become very large or encompass the entire rectum without containing malignancy. Bleeding, diarrhea, mucous discharge, prolapse, and constipation are common presenting symptoms. Clinical exam, endorectal ultrasound, and biopsy identify nearly all invasive malignancies in these tumors. Appropriate treatment is removal of the tumor while preserving anal sphincter function. The method of treatment is determined by the tumor location, tumor size, and patient factors (comorbidities, treatment preference, and existing sphincter function). Simple snare excision treats pedunculated villous adenomas. Low- and midrectal tumors are treated by transanal techniques, including snare excision with staged fulguration, transanal excision, or circumferential mucosectomy. These approaches offer low morbidity and preserve sphincter function but carry a substantial rate of recurrence, and therefore close postoperative follow-up is an integral part of this type of management. Recurrences are usually asymptomatic and can be treated with fulguration or transanal excision. Transabdominal or laparoscopic rectal excision best treats larger tumors and more proximal rectal villous tumors. Abdominoperineal resection should rarely be necessary to treat benign rectal villous tumors.

KEYWORDS

Rectal villous tumors - transanal excision - rectal mucosectomy

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