Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers

Guglielmo Niccolò Piozzi; Ania Przedlacka; Rauand Duhoky; Oroog Ali; Yasser Ghanem; Richard Beable; Antony Higginson; Jim S Khan

doi:10.1007/s00464-024-10829-4

Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers

Surg Endosc. 2024 May 6. doi: 10.1007/s00464-024-10829-4. Online ahead of print.

Authors

Guglielmo Niccolò Piozzi¹, Ania Przedlacka¹, Rauand Duhoky¹, Oroog Ali^{1

2}, Yasser Ghanem³, Richard Beable⁴, Antony Higginson⁴, Jim S Khan^{5

6}

Affiliations

¹ Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
² Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK.
³ Department of General Surgery, Isle of Wight NHS Trust, Newport, UK.
⁴ Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁵ Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK. jim.khan@porthosp.nhs.uk.
⁶ University of Portsmouth, Portsmouth, UK. jim.khan@porthosp.nhs.uk.

PMID: 38710889
DOI: 10.1007/s00464-024-10829-4

Abstract

Background: Transanal minimally invasive surgery (TAMIS) is an advanced technique for excision of early rectal cancers. Robotic TAMIS (r-TAMIS) has been introduced as technical improvement and potential alternative to total mesorectal excision (TME) in early rectal cancers and in frail patients. This study reports the perioperative and short-term oncological outcomes of r-TAMIS for local excision of early-stage rectal cancers.

Methods: Retrospective analysis of a prospectively collected r-TAMIS database (July 2021-July 2023). Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated.

Results: Twenty patients were included. Median age and body mass index were 69.5 (62.0-77.7) years and 31.0 (21.0-36.5) kg/m². Male sex was prevalent (n = 12, 60.0%). ASA III accounted for 66.7%. Median distance from anal verge was 7.5 (5.0-11.7) cm. Median operation time was 90.0 (60.0-112.5) minutes. Blood loss was minimal. There were no conversions. Median postoperative stay was 2.0 (1.0-3.0) days. Minor and major complication rates were 25.0% and 0%, respectively. Seventeen (85.0%) patients had an adenocarcinoma whilst three patients had an adenoma. R0 rate was 90.0%. Most tumours were pT1 (55.0%), followed by pT2 (25.0%). One patient (5.0%) had a pT3 tumour. Specimen and tumour maximal median diameter were 51.0 (41.0-62.0) mm and 21.5 (17.2-42.0) mm, respectively. Median specimen area was 193.1 (134.3-323.3) cm². Median follow-up was 15.5 (10.0-24.0) months. One patient developed local recurrence (5.0%).

Conclusions: r-TAMIS, with strict postoperative surveillance, is a safe and feasible approach for local excision of early rectal cancer and may have a role in surgically unfit and elderly patients who refuse or cannot undergo TME surgery. Future prospective multicentre large-scale studies are needed to report the long-term oncological outcomes.

Keywords: Rectal cancer; Robotic surgery; Robotic transanal surgery; TAMIS; Total mesorectal excision.