Villous Adenoma, a Surgical Dilemma

Introduction  The dilemma of radical versus conservative treatment ultimately confronts every surgeon who treats a patient with a villous adenoma (Fig 1). These friable, velvety, often extensive tumors defy precise diagnosis. They may grow to encompass the entire circumference of the bowel. Despite multiple biopsies without evidence of malignancy, the question often remains whether malignancy actually exists but has not been biopsied. Compounding this dilemma is the increased operative risk in the advanced age group in which this lesion commonly occurs. Is the surgeon justified in performing local excision of these tumors when multiple biopsies and gross appearance reveal no evidence of malignancy? Or should all villous tumors be treated by more extensive resection?⁵ This study offers support for the conservative approach in the management of these tumors.

Materials and Methods  Grossly malignant lesions histologically confirmed as such were excluded from this study. Only sessile tumors were included which