TAMIS for Recurrent Cancer of the High Rectum (25 cm from the Anal Verge) in a Patient with Serious Associated Disorders (Rescue Surgery)

• Published in: Iranian journal of colorectal research Vol. 9; no. 2; pp. 82 - 85
• Main Authors: Alessandro Verbo, Vito Laterza, Marco Montagna, Giovanni Di Palma, Giovanni Moschetta, Annamaria Martullo
• Format: Journal Article
• Language: English
• Published: Shiraz University of Medical Sciences 01.06.2021
• Subjects: laparoscopic surgery; rectal cancer; transanal minimally invasive surgery (tamis)
• ISSN: 2783-2430
• DOI: 10.30476/acrr.2021.91751.1106

INTRODUCTION Transanal Minimally invasive surgery (TAMIS) is indicated for benign lesions of the rectum distant up to 5 cm and not exceeding more than 1/3 of the rectal circumference; for early stage malignancies confined to the submucosa (T1 sm1 according to the Kikuchi classification); for cancers after complete response to neoadiuvant treatments or with T1 residue (due to a risk of mesorectal positive lymph node between 3-6%); for T2-T3 N0 in patients who cannot undergo major surgical resections due to a compromised general (rescue surgery). TAMIS is especially recommended for neoplasms located at a distance between 5 and 18 cm from the anal verge. CASE PRESENTATION We performed TAMIS on a 72-year-old patient diagnosed with diffuse polyposis syndrome (FAP), with multimorbidity and a history of recurrences, all treated with surgical resection, AND with a new recurrence on the ileo-rectal anastomosis at about 25 cm from the anal verge. A rectoscopy and a total body CT were performed (anastomotic level; size 2 cm; staging: cT1-2, N0, M0; histology: adenocarcinoma). The final decision after multidisciplinary meeting was for TAMIS, due to high intra- and post-operative risk contraindicating major surgery. Data regarding total operating time, blood losses, length of stay, surgical and general intra and post-operative complications, resumption of nutrition and therapies (antibiotics and pain relievers) were collected. The operation was successful, with a total operating time of 55 minutes, and an estimated blood loss of 20 ml. The patient was rapidly mobilized and nutrition promptly resumed. The length of stay was 3 days. We did not observe any complications. CONCLUSION We showed for this patient the feasibility and safety of TAMIS resections at greater distances than those normally recommended.