AB056. SOH25_AB_367. Transanal minimally invasive surgery: a stab in the dark?
General Surgery I

AB056. SOH25_AB_367. Transanal minimally invasive surgery: a stab in the dark?

Elaine Kelly1, Patrick Boland1, Cathleen McCarrick1, Mohammad Khan1, Conor Shields1, Ronan Ambrose Cahill1,2

1Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; 2Centre for Precision Surgery, University College Dublin, Catherine McAuley Education & Research Centre, Dublin, Ireland

Background: Transanal minimally invasive surgery (TAMIS) improves outcomes when appropriately applied. This rectum-preserving approach is indicated in large benign, and early malignant rectal neoplasia. Preoperative staging of such lesions is often inaccurate. This study reports preoperative, perioperative and postoperative metrics for TAMIS at this centre.

Methods: For this retrospective observational cohort study, hospital inpatient enquiry (HIPE), multidisciplinary team (MDT), and electronic patient records were accessed and reviewed. Patient demographic, preoperative, perioperative, postoperative and pathological data were collected.

Results: In total, 50 TAMIS excisions were performed on 45 patients (11 females) over a 5-year period. Malignancy was present in 16 of the pathological specimens. Pre-operative magnetic resonance imaging (MRI) was performed in 20 patients with sensitivity of 66.6% and specificity of 63.6%. Sensitivity of endoscopic biopsy was 45.5%. Clinician impression yielded a sensitivity of 43.8% and specificity of 88%. In six cases cancer was not identified/predicted prior to TAMIS. Specimens were fully intact in 44 cases, there were seven positive margins and one positive margin (“R1”) resection. Six patients required proctectomy, adjuvant chemoradiotherapy or both. Major postoperative morbidity (Clavien-Dindo greater than 3) occurred in four cases. At long-term follow-up there were two strictures and three patients with low anterior resection syndrom (LARS) like symptoms. There were six incidences of excision site recurrence, all in the benign cohort. Four of these recurrences were adenomas. Median length of stay was 1 day.

Conclusions: TAMIS is an effective and safe approach to significant rectal neoplasia. Perioperative outcomes compare favorably to radical resection and international standards. This is despite the poor performance of preoperative investigational methods at predicting cancer presence.

Keywords: Preoperative staging; rectal cancer; rectal neoplasia; transanal minimally invasive surgery (TAMIS); surgical outcomes

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab056
Cite this abstract as: Kelly E, Boland P, McCarrick C, Khan M, Shields C, Cahill RA. AB056. SOH25_AB_367. Transanal minimally invasive surgery: a stab in the dark? Mesentery Peritoneum 2025;9:AB056.

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