Background: Transanal excision is commonly used to treat lesions of the anorectum. It avoids the morbidity of radical pelvic surgery, while allowing for complete histopathological examination of the lesion.
Aim: The aim of this study was to look at the spectrum of disease treated by transanal excision, and their outcomes, in a tertiary care institute.
Methods: Records of patients who underwent transanal excision between 2004 and 2008 were reviewed. Patients were divided into three groups. (1) Resection for benign disease (2) Curative and (3) Palliative resection for malignant disease.
Results: Forty six patients underwent transanal excision, 21 for benign and 25 for malignant disease, 20 with curative and 5 with palliative intent. Tubulovillous adenomas and hyperplastic polyps were the commonest benign lesions. The mean follow up was 18.6 months (4-49). There was one recurrence and one patient returned with liver metastasis. Seventeen patients with adenocarcinoma, two with melanoma and one with verrucous carcinoma underwent curative resection. Three required a second local excision and two abdominoperineal excision. Mean follow up was 28 months (4-63). There were three recurrences, one requiring a local excision and two abdominoperineal excision. Four patients with malignant melanoma and one with adenocarcinoma underwent palliative resection. All these patients had good symptom palliation.
Conclusion: Transanal excision, when technically feasible, remains the treatment of choice for benign disease of the rectum. It offers good palliation of local symptoms in advanced malignant disease. It can be used in a carefully selected group of patients with early rectal cancer.