Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma

Introduction Transanal endoscopic microsurgery (TEM) is an accepted way of excising rectal adenomas with low morbidity and mortality, avoiding major resectional surgery. However, there are no agreed criteria for surveillance following TEM. The purpose of this study was to identify criteria to guide surveillance programmes, thus reducing the surveillance burden for those patients at low risk of recurrence. Patients and methods Patients who had undergone TEM for rectal adenomas were identified, and a retrospective review of patient, pathological and histological parameters was performed. Results Seventy‐five (40 male) patients were identified; median age 70 years (39–85). There were seven tubular, 33 tubulo‐villous and 35 villous adenomas. All were considered completely excised by the operating surgeon. Forty‐seven (62.7%) were reported as being completely excised histologically. There was no significant association between recurrence at 6 months and sex, age, type or position of adenoma, height above the anal verge, or degree of dysplasia. Recurrence rates at six months were 0% for the completely excised adenomas and 21.4% for the incompletely excised ones; this was statistically significant (Pearson χ2, P