Transanal minimally invasive surgery for rectal cancer

Abstract

Due to the increased uptake of rectal cancer screening and the increasing rates of complete clinical response to chemoradiotherapy, more early‐stage and down‐staged rectal cancers are being treated. This has triggered surgeons to question the necessity for proctectomy and its associated morbidity and consider local excision and organ preservation in selected cases. Transanal minimally invasive surgery (TAMIS) has evolved as an oncologically safe yet cost‐effective platform for local excision of rectal tumors using traditional laparoscopic instruments. This review highlights the recent advances and current role of TAMIS in the treatment of rectal cancer.

The first robotic transanal minimally invasive surgery in Ireland: a case-based review

“…In our case, a T1 cancer was treated by the R-TAMIS technique. While TME remains the gold standard curative treatment for rectal cancer, it is associated with significant risk of morbidity and debilitating effects on anorectal and urogenital function [10]. Such factors have prompted the need to individualise care and to consider if organ-preserving approaches may be appropriate [10].…”

“…While TME remains the gold standard curative treatment for rectal cancer, it is associated with significant risk of morbidity and debilitating effects on anorectal and urogenital function [10]. Such factors have prompted the need to individualise care and to consider if organ-preserving approaches may be appropriate [10]. In the USA and Europe, full-thickness local excision is indicated for T1N0 rectal cancers with low-risk pathological features [10].…”

“…Such factors have prompted the need to individualise care and to consider if organ-preserving approaches may be appropriate [10]. In the USA and Europe, full-thickness local excision is indicated for T1N0 rectal cancers with low-risk pathological features [10]. The main concern regarding local excision is the potential under-treatment of T1 cancers that are lymph node-positive.…”

“…The main concern regarding local excision is the potential under-treatment of T1 cancers that are lymph node-positive. However, it has been shown that the overall rate of nodal metastases in T1 rectal cancers is as low as 6% if there are no adverse features present [10]. It has also been demonstrated that local excision of T1 lesions does not impact cancerspecific survival compared to radical resection with TME [10].…”

“…However, it has been shown that the overall rate of nodal metastases in T1 rectal cancers is as low as 6% if there are no adverse features present [10]. It has also been demonstrated that local excision of T1 lesions does not impact cancerspecific survival compared to radical resection with TME [10]. For these reasons, TAMIS is now widely accepted as an appropriate therapy for carefully selected T1 rectal cancers [10] In conclusion, we report our first experience of a patient with early-stage rectal cancer successfully managed by R-TAMIS.…”