RT Journal
A1 Gearhart SL
T1 Tems for rectal adenomas: Comment on “transanal endoscopic microsurgery in small, large, and giant rectal adenomas”
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD December 1
VO 147
IS 12
SP 1101
OP 1101
DO 10.1001/archsurg.2012.1969
UL http://dx.doi.org/10.1001/archsurg.2012.1969
AB 
Historically, large lesions of the rectum have been referred for resection using an abdominal approach, often leaving some patients with long-term defecatory dysfunction. As technology has advanced, newer procedures are available to remove these polyps in less-invasive ways. As the authors pointed out, the outcomes of these different methods should be carefully examined so that the care of patients with cancer is not compromised. It is comforting to know that the malignancy rate in large rectal adenomas is low and that perhaps in some cases, the TEMS procedure can serve as an additional safe excisional biopsy technique, allowing for additional therapy to be given prior to a larger, more definitive resection. Finally, what is lacking in the management of these patients is more definitive preoperative staging methods, which would take the guess work out of the equation.