Abstract
Introduction
In rectal tumors, preoperative biopsies frequently fail to diagnose an invasive carcinoma. Endorectal ultrasound is considered a useful adjunct in preoperative staging of rectal tumors. However, feasibility of endorectal ultrasound and its role in therapeutic decision-making in presumed rectal adenomas is sparsely studied.
Methods
Endorectal ultrasound was performed in 268 tumors referred for local excision because biopsies showed tubulovillous adenoma. Feasibility of endorectal ultrasound was studied and ultrasound staging was compared with definite histopathologic findings.
Results
In 231 tumors, endorectal ultrasound was technically feasible (86 percent). Median distance from the dentate line was 11 cm in nonassessable tumors and 7 cm in assessable tumors (P < 0.001). In 21 tumors, endorectal ultrasound was not conclusive, mainly in tumors being recurrent or after recent endoscopic manipulation (P < 0.001). With endorectal ultrasound the rate of preoperative missed carcinomas could be reduced from 21 to 3 percent (P < 0.01). In diagnosing tubulovillous adenomas, sensitivity and specificity of endorectal ultrasound was 89 and 86 percent, respectively.
Conclusions
Endorectal ultrasound is technically feasible in almost all presumed rectal adenomas, referred for local excision. Proper endorectal ultrasound interpretation is possible in 78 percent of all presumed rectal adenomas. Endorectal ultrasound is very reliable in diagnosing tubulovillous adenomas, and therapeutic decision-making regarding local excision vs. radical surgery based on endorectal ultrasound is valid.
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Langer C, Liersch T, Suss M, et al. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003;18:222–9.
Buess G, Kipfmuller K, Ibald R, et al. Clinical results of transanal endoscopic microsurgery. Surg Endosc 1988;2:245–50.
de Graaf EJ. Transanal endoscopic microsurgery. Scand J Gastroenterology Suppl 2003;239:34–9.
Galandiuk S, Fazio VW, Jagelman DG, et al. Villous and tubulovillous adenomas of the colon and rectum. A retrospective review, 1964–1985. Am J Surg 1987;153:41–7.
Taylor EW, Thompson H, Oates GD, Dorricott NJ, Alexander-Williams J, Keighley MR. Limitations of biopsy in preoperative assessment of villous papilloma. Dis Colon Rectum 1981;24:259–62.
Baron PL, Enker WE, Zakowski MF, Urmacher C. Immediate vs. salvage resection after local treatment for early rectal cancer. Dis Colon Rectum 1995;38:177–81.
Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S. Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 2005;48:429–37.
Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 1999;42:770–5.
Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging: a meta-analysis. Radiology 2004;232:773–83.
Kim JC, Kim HC, Yu CS, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging. Am J Surg 2006;192:89–97.
Sailer M, Leppert R, Kraemer M, Fuchs KH, Thiede A. The value of endorectal ultrasound in the assessment of adenomas, T1- and T2-carcinomas. Int J Colorectal Dis 1997;12:214–9.
Kim JC, Yu CS, Jung HY, et al. Source of errors in the evaluation of early rectal cancer by endoluminal ultrasonography. Dis Colon Rectum 2001;44:1302–9.
Solomon MJ, McLeod RS. Endoluminal transrectal ultrasonography: accuracy, reliability, and validity. Dis Colon Rectum 1993;36:200–5.
Worrell S, Horvath K, Blakemore T, Flum D. Endorectal ultrasound detection of focal carcinoma within rectal adenomas. Am J Surg 2004;187:625–9.
Winde G, Nottberg H, Keller R, Schmid KW, Bunte H. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39:969–76.
Heintz A, Morschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 1998;12:1145–8.
Floyd ND, Saclarides TJ. Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 2006;49:164–8.
Stipa F, Burza A, Lucandri G, et al. Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5-year follow-up study. Surg Endosc 2006;20:541–5.
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Doornebosch, P.G., Bronkhorst, P.J.B., Hop, W.C.J. et al. The Role of Endorectal Ultrasound in Therapeutic Decision-Making for Local vs. Transabdominal Resection of Rectal Tumors. Dis Colon Rectum 51, 38–42 (2008). https://doi.org/10.1007/s10350-007-9104-4
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DOI: https://doi.org/10.1007/s10350-007-9104-4