Revisit the Benefit of Transanal Local Excision for Two Cases of Large Prolapsing Malignant Rectal Polyps.

Abstract

Transanal local excision was traditionally practiced to remove rectal polyps or early rectal tumor. Since 1980, Buess et al. have recommended the use of endoscopy technology for transanal endoscopic microsurgery (TEM). This technique was not popular due to technical issues of difficult positioning, tricky technique especially when it was introduced in the pre-laparoscopy era. With the inception of flexible endoscopy technology, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) came in as alternative options for colorectal polyps. However, both these flexible endoscopy techniques have their disadvantages. The earlier had the issues of fragmented specimens, the latter is technically more challenging with higher risk of perforation/bleeding. Therefore, the traditional transanal excision surgery remained popular and a cost-effective option. Here, we reported 2 cases of large malignant rectal polyps with broad-based pedicle. Both the patients' polyps are prolapsing and can be everted out from the anal canal. With this specific anatomical criterion, we observed that the surgical treatment can be simplified with conventional transanal local excision with minimal blood loss and quicker and good complete resection rate. Adding that, it abates the cost from the aforementioned newer endoscopic technique.