Abstract

BackgroundLocal excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms.MethodsAll patients who underwent TAMIS from January 2016 to January 2020 at St. Olav’s University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications.ResultsThere were 76 patients (42 men, mean age was 69 years [range 26–88 years]), The mean tumour level was 82 mm (range 20–140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8–73 mm). Three patients experienced complications needing intervention (Clavien–Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer.ConclusionsTAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.

Highlights

  • Local excision is an important part of the treatment of rectal neoplasms, most commonly used in treatment of adenomas as a supplement to endoscopic mucosal or submucosal excisions (EMR/ESD)

  • In the group of 72 patients with either adenoma or adenocarcinoma, magnetic resonance imaging (MRI) was performed in 42 patients (58%)

  • This study supports the applicability and safety of the Transanal minimally invasive surgery (TAMIS) procedure in treatment of rectal neoplasms, as we observed a low rate of major complications and a low recurrence rate

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Summary

Introduction

Local excision is an important part of the treatment of rectal neoplasms, most commonly used in treatment of adenomas as a supplement to endoscopic mucosal or submucosal excisions (EMR/ESD). Endoscopic excisions and local excisions by the transanal endoscopic microsurgery (TEM) technique have been shown to have comparable results [1]. Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms. Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Conclusions TAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours

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