The management of villous tumours of the large bowel

Thirty patients with villous tumours of the rectum are described. With the criterion that invasion of the muscularis mucosae is necessary to make a diagnosis of malignant change the incidence of malignancy was 17 per cent. The technique of local excision per anum using submucosal infiltration is described, and the management of large mucosal defects and of total papillomatosis of the rectum is discussed. Local infection and incontinence have not been features in this series and every patient has had a sphincter-conserving operation. The recurrence rate was 10 per cent and recurrences can be treated by further local excision.