Based on their experience and results. Chiu and Spencer believe in giving preference to a less aggressive procedure for the treatment of villous adenoma. Regarding the danger of carcinoma, a difference between the typical unilateral or circular “area-like” growth of adenoma and the pedunculated villous adenoma seems, in our opinion, to be significant. We are of the opinion that even with the pedunculated lesions, which have a lesser tendency to cancerous degeneration, one should stick to the total removal as the most secure therapeutic procedure. A change to the recommended Chiu and Spencer “conservative treatment of villous lesions as appropriate when invasive carcinoma is not detected” is risky.
The thought that a “conservative procedure for the treatment of villous lesions” may be used in community hospitals in Europe and in the United States by proctologic colleagues, after reading the article of Chiu and Spencer, is alarming.