Replacing Transanal Excision with Transanal Endoscopic Microsurgery and/or Transanal Minimally Invasive Surgery for Early Rectal Cancer

Abstract

The use of local resection of rectal polyps and early rectal cancer has progressed to become the standard of care in most institutions with a colorectal surgery specialist. The use of transanal excision (TAE) with anorectal retractors and standard instrumentation has been supplanted by the application of endoscopic techniques which allow direct video augmented visualization. The transanal endoscopic microsurgery method provides a 3D view and works under a constant flow of air to keep the rectal vault open. Instruments capable of accomplishing a surgical excision and suture closure work through a long 4 cm tube set at the anal canal. The newest version of TAE is transanal minimally invasive surgery which is similar to a single-site laparoscopic technique using a hand access port at the anal canal to maintain a seal for insufflation of the rectum, regular 2D video camera for visualization, and laparoscopic instrumentation through the port in the anus. Each of these techniques is described in detail and the outcomes compared, which show the progress being made in this area of colorectal surgery.

Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China

“…The 3mm resection margin was recommended by “National Comprehensive Cancer Network” (NCCN) for the principle of local excision in terms of curative intent[ 19 ], as implemented in our study. However, trans-anal local excision was performed using a variety of other standards of resection margin, from 5 mm to 10 mm[ 20 , 21 ]. It is speculated that positivity of resection margin might be decreased if the 5 mm (or 10 mm) margin applied, indicating for rectal malignancy treated by the TAMIS surgery, an enlarged resection margin might be safer.…”

Adjuvant radiotherapy after local excision of rectal cancer

“…Over recent decades technical developments have enabled ongoing refinement to local excisional procedures for rectal cancer [2,3]. Traditional transanal excision has been largely superseded by the use of an endoscopic platform providing clear visualization even to the upper rectum, such as transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS) or transanal endoscopic operations (TEO).…”

Management of colorectal T1 carcinoma treated by endoscopic resection from the Western perspective

“…6,7 Transanal full-thickness excision for early rectal cancer avoids lymph node resection and limits the morbidity of surgery; however, it also limits exact disease staging. 6,7,103 In this context, micrometastasis can be missed. 65 Transanal full-thickness excision techniques encompass conventional TAE, transanal endoscopic microsurgery (TEMS), and transanal minimally invasive surgery among others.…”

“…Partial colectomy, lower anterior resection with total mesorectal excision (TME), and abdominoperineal resection are curative treatments for colorectal cancer . Transanal full‐thickness excision for early rectal cancer avoids lymph node resection and limits the morbidity of surgery; however, it also limits exact disease staging . In this context, micrometastasis can be missed …”