Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2018; 10(6): 137-144
Published online Jun 15, 2018. doi: 10.4251/wjgo.v10.i6.137
Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China
Nan Chen, Yi-Fan Peng, Yun-Feng Yao, Jin Gu
Nan Chen, Yi-Fan Peng, Yun-Feng Yao, Jin Gu, Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
Author contributions: Chen N and Yunfeng Yao designed the study; Chen N and Yao YF performed the TAMIS surgeries; Chen N and Peng YF drafted the manuscript; Chen N, Peng YF and Yao YF contributed equally to this paper.
Supported by Science Foundation of Peking University Cancer Hospital, No. 2017-13.
Institutional review board statement: The study was reviewed and approved for publication by our institutional reviewer.
Informed consent statement: All study participants provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nan Chen, MD, PhD, Attending Doctor, Lecturer, Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China.
Telephone: +86-10-88196086 Fax: +86-10-88196086
Received: March 11, 2018
Peer-review started: March 12, 2018
First decision: April 10, 2018
Revised: April 26, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: June 15, 2018

To evaluate the feasibility and safety of trans-anal minimally invasive surgery (TAMIS) from single institute in China.


A retrospective review was conducted for patients with rectal neoplasia, who underwent TAMIS using single incision laparoscopic surgery-Port from January 2013 till January 2016 by a group of colorectal surgeons from Gastrointestinal Center Unit III, Peking University Cancer Hospital. Patients’ demographic data, surgical related information, post-operational pathology, as well as peri-operative follow-up were all collected.


Twenty-five patients with rectal neoplasia were identified consequently. Complete full-thickness excision was achieved in all cases without conversion. 22 (88%) cases had rectal malignancies [6 were adenocarcinomas and 16 were neuroendocrine tumors (NET)], while 3 patients had adenomas. Mean surgical duration was 61.3 min, and mean post-operative stay were 2.7 d. Post-operational examination demonstrated 5 cases had positive resection margin: 2 adenocarcinoma cases and 1 NET case with positive lateral margin, and the other 2 NET cases with positive basal margin. The curve of operation time for TAMIS cases suggested a minimum of 10 cases for a laparoscopic surgeon proficient with this technique.


TAMIS was demonstrated to be reproducible and safe, with a relatively short learning process for laparoscopic surgeons in selected cases for rectal neoplasia. Long-term oncological outcome needs to be determined by further investigation.

Keywords: Rectal neoplasia, Resection margin, Trans-anal minimally invasive surgery

Core tip: Local excision was regarded as the conversional treatment for early stage rectal neoplasia. Recent evidence, however, revealed certain disadvantages. Minimally invasive surgery has been adopted in treating rectal cancer. This study was the first well-documented retrospective trail demonstrating the safety and feasibility of trans-anal minimally invasive surgery. Short-term follow-up showed no serious post-operative complications (over grade IIIa by CD classification), meanwhile, lateral resection margin should be evaluated pathologically and surgeons proficient for laparoscopic surgery would be confident over the learning curve regarding 10 cases.