A 55-year-old woman has a 6cm villous adenoma of the rectum at 8cm from the anal verge, with biopsy showing high-grade dysplasia but no invasive cancer. What is the most appropriate surgical approach?
- A Transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) ✓
- B Transanal excision (TAE) using conventional Parks technique
- C Anterior resection with total mesorectal excision
- D Abdominoperineal resection
Explanation
Transanal endoscopic microsurgery (TEM) or TAMIS provides excellent visualization and allows full-thickness local excision of large rectal adenomas at mid or upper rectal levels (beyond 6-8 cm from the anal verge) that cannot be adequately accessed by conventional transanal excision. For benign or high-grade dysplastic lesions without evidence of invasive cancer, local excision is curative and avoids the morbidity of radical resection. TEM/TAMIS achieves superior en bloc R0 resection compared to conventional piecemeal endoscopic techniques, with lower recurrence rates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.