Objective

Our objective is to provide evidence of  the feasibility and safety of a stapled resection in TAMIS for the removal of rectal lesions.

Background

• Resection of rectal polyps or early staged rectal cancers is an active challenge in colorectal surgery

• Lesions are traditionally removed endoscopically, via transanal minimally invasive surgery (TAMIS), or surgical resection

• TAMIS is a novel surgical approach used for local excisions of rectal lesions

Potential benefits of TAMIS resection:

• Potentially a feasible treatment option for early cancers and precancerous polyps

• Fast recovery time

• Avoid unnecessary segmental resections

• “Big Biopsy”  to stratify patients who do need surgical resection

Potential limitations of TAMIS resection:

• Risk for conversion to abdominal approach for peritoneal entry

• Learning curve and specialized training needed given port placement

Question: Is there another easy, effective, and safe way to resect lesions in TAMIS?

Methods

• Study design: Retrospective observational study

• Data collection: Patient chart and pathology reports review

• Participants: Patients with pelvic malignancy undergoing Stapled TAMIS from December 2017 to December 2025 by a single surgeon based in Vancouver, Canada (14 females and 11 males)

• Ethics approval: Approved by the Fraser Health Ethics Research Board

 

Preliminary Results (n = 6)

Lesion characteristics:

• Anterior 66% (4) 

• Posterior 16% (1) 

• Lateral 16% (1) 

• Largest dimension of an excised lesion ranged from 2 to 5.5 cm

• Distance to the anal verge ranged from 9 to 15 cm

Pre-Operative Pathology:

• High-grade dysplasia 50% (3)

• Benign non neoplastic 16% (1)

• Known malignancies 16% (1)

• Discordant or suspected neoplastic 16% (1)

Operative Details:

• Procedure averaged of 49 minutes

• All lesions removed without fragmentation

• No peritoneal entry occured

Post-Surgery:

• All patients were discharged the same-day 

• No patients required readmission within 30 days

• No patients experienced intraoperative or postoperative complications 

Conclusion:

• Stapled resection in  TAMIS is a safe procedure for the removal of some rectal lesions 

• Select lesions can be removed with stapling as a means of avoiding peritoneal entry during resection

• Operative times, hospital length of stay, and complications  are comparable to standard resection

 

Further/Ongoing Work (n=25)

Lesion characteristics:

• Anterior 64% (16) 

• Posterior 24% (6) 

• Lateral 8% (2) 

• Largest dimension of an excised lesion ranged from 1.5 to 5.5 cm

• Distance to the anal verge ranged from 6 to 15 cm

Pre-Operative Pathology:

• Benign neoplasms 24% (6)

• Known malignancies 20% (5)

• Missing or undocumented preoperative indication 16% [4]

• Discordant or suspected cancer 12% (3)

• High-grade dysplasia 12% (3)

• Not biopsied 12% (3)

• Benign non neoplastic 4% (1)

Operative Details:

• Procedures averaged  42 minutes

Post-Surgery:

• 92% patients were discharged the same-day (23/25)

• No patients required readmission within 30 days

Next Steps/Future Work:

• In-depth pathologic review of resection lesions including margin status - ONGOING

• Determine criteria for patient eligibility

• Determine lesion characteristics which make polyps most amenable to this approach

• Review long-term oncologic outcomes