Published online Jun 15, 2018. doi: 10.4251/wjgo.v10.i6.137
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.
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.