Performance review of TEMS(Transanal Endoscopic MicroSurgery)/TAMIS(TransAnal Minimally Invasive Surgery) for excision of rectal lesions in a District General Hospital


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Arun P Shanmuganandan1,Bernadette Pereira1,Nicholas Farkas1,Muhammed Siddiqui1,Said Mohamed1,Robert Swift1,Al mutaz Abulafi1
1Croydon University Hospital NHS Trust

Abstract

Background

Bowel cancer screening programs have meant rectal cancers often are detected early. Existing treatments such as Total Mesorectal Excision (TME) carry significant morbidity and mortality. Alternative surgical options such as Transanal Endoscopic Micro-Surgery (TEMS) and TransAnal Minimally Invasive Surgery (TAMIS) may offer safer organ and function preserving therapy. Our study reviews a single centre experience with TEMS and TAMIS procedures managing rectal lesions.

Method

Retrospective analysis of patients who underwent TEMS/TAMIS procedures from August 2011-August 2016.

Results

41 patients underwent transanal excision using TEMS (KARL-Storz) or single port TAMIS (Covidien) kits. All patients went through the colorectal MDT with standardized MRI reporting. Average age was 70yrs (range=40-86). Mean hospital stay was 2.7 days. Complications- 1 had post-operative bleeding that required repeat surgery; 1 developed a pre-sacral collection that was treated with antibiotics.

13 patients had tubulo-villous adenoma with high-grade dysplasia, 9 had invasive adenocarcinoma demonstrated on histology (3=T1SM1, 3=T1SM2, 3=T1SM3) and 1 had neuroendocrine tumor, others demonstrated benign dysplasia (15 had tubulo-villous adenoma with low-grade dysplasia, 3 with sessile serrated adenomas). 8/9 cancers had R0excision. One patient with T1SM3, who had R1 excision and another with T1SM2 and poor prognostic features on histology, underwent adjuvant chemoradiation. All patients had flexible sigmoidoscopy at 3 months. 5/41 had recurrent benign polyps (3 underwent endoscopic resections, 2 repeat TEMS) with no cancer recurrence. No significant pain was reported, one patient reported mild passive incontinence. Mean follow-up is currently 12.5 months.

Conclusion

TEMS/TAMIS excision offers a safe surgical option preserving organ and function in carefully selected early rectal lesions. Prospective randomised controlled trials comparing TEMS/TAMIS with TME incorporating longer-term follow-up are needed to confirm its place in the surgical armamentarium for early rectal cancers.