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TAMIS FOR BENING AND MALIGNANT EXTRA-PERITONEAL RECTAL LESIONS
Diego Naiderman*, Rafael Lopez Fagalde, Gaston Jury, Martin E. Dolan, Lady Trinchero, Diego Cano
centro de estudios digestivos, Mar del Plata, Buenos Aires, Argentina
INTRODUCTION: Current screening methods allow professionals to diagnose rectal lesions at earlier stage with great success regarding local resection without the need of a major surgical procedure. Transanal Minimally Invasive Surgery (TAMIS) consists in removing rectal lesions using transanal devices with usual laparoscopic instrumentation. In our country, we could not find reports of series this innovative technique. The aim of the study was to assess the feasibility and safety of removing extra-peritoneal benign and malignant lesions of the rectum using TAMIS in a single Medical center from Argentina.
MATERIALS AND METHODS: Retrospective cohort study conducted between March 2013 and September 2016 at a single medical center in Mar del Plata, Argentina. The medical charts of patients who underwent a TAMIS procedure for the following indications: benign lesions ≥ 3 cm; neuroendocrine tumors less than 2 cm; T1N0 tumors with no adverse histological features; patients with adenocarcinoma T2N0 with high surgical risk, or those rejecting radical surgery; patients with a complete clinical remission following neoadjuvant therapy and those doubtful pathological response. All procedures were carried out by the same surgeon. Patients were placed in lithotomy position. Transanal specific devices and laparoscopic instrumental were applied as well as a high flow insufflator with a CO2 pressure of 15 mmhg. Procedural complications were stratified based on the Clavien-Dindo Classification of Surgical Complications.
RESULTS: Of the 21 patients who satisfied our inclusion criteria and underwent TAMIS, 5 had general anesthesia and 16 spinal anesthesia. The mean surgical time was 44 minutes.
The average sizes of the lesions were 4.1 cm (0.7-9 cm), and located at 6.1 cm (3-8.5) from the anal margin. The surgical site was left open in 20 patients .Of the 21 procedures performed, 90.5% (95% CI 71.9-98.3) had a complete resection of the lesion. In 19 cases unfragmented samples were taken. Eight (38%) of the lesions were benign, one was a carcinoid tumor and twelve (57%) adenocarcinomas: 1 ypT0, 2 pTis, 3 pT1 and 6 pT2 (three of them were substaged through MRI). None of the patients were lost during the follow up until now, with a mean time of 22.1 months. There were three recurrences, two of them were benign lesions treated with an endoscopic procedure. Five patients (23.8%) suffered a surgical complication (one degree 1 and four degrees 2) but none of them suffered postoperative stenosis. None of the patients died during follow up.
CONCLUSIONS: In our setting the use of TAMIS for the treatment of extraperitoneal well selected rectal lesions appears effective and safe. Prospective randomized trials are needed to further evaluate this technique against standard surgical procedure .
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