Over a decade with Transanal Minimally Invasive Surgery (TAMIS): Analyzing short- and long-term oncological outcomes of 208 patients with rectal lesions

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INTRODUCTION: Transanal Minimally Invasive Surgery (TAMIS) is frequently used to treat rectal lesions that are not amenable to conventional polypectomy or endoscopic resection. Few studies have reported long-term outcomes of TAMIS. This study aims to assess the long-term outcomes in patients who underwent TAMIS for rectal lesions. METHODS: Patients who underwent TAMIS for rectal neoplasms at a tertiary care center between June 2010 and August 2023 were retrospectively reviewed. The assessment of oncological outcomes, reported separately for benign and malignant lesions, was limited to patients with adenomatous polyps, serrated polyps, or adenocarcinomas as indicated in the postoperative histopathology report. The primary outcomes were long-term oncological outcomes, including local recurrence, distant metastasis, mortality, disease-free and overall survival rates. RESULTS: The current study included a total of 208 individuals, of whom 74 (35.6 %) were female, with a median age of 64 (19.3) years. Upon postoperative histopathological examination, adenomatous lesions were identified in 109 (52.4 %) patients, serrated adenoma in 7 (3.4 %) patients, negative pathology in 18 (8.7 %) patients, and adenocarcinoma in 74 (35.5 %) patients. The median follow-up duration was 37 months. During the follow-up period, local recurrence occurred in 1 patient (0.8 %) with benign disease, 16 months after TAMIS. Additionally, recurrence occurred in 8 (9.4 %) patients with malignant disease at a median follow-up of 23.5 months. Distant metastasis was observed in 1 patient (0.8 %) who initially had benign disease seven months after experiencing malignant recurrence. Furthermore, distant metastasis was noted in 5 patients (5.9 %) with malignant disease. No disease-related mortality was recorded during the follow-up period for benign lesions. However, 5 (5.9 %) patients with malignant disease experienced mortality associated with rectal adenocarcinoma. The 3-year disease-free and overall survival rates for patients with malignant disease were 91 % and 96.6 % (p = 0.015), respectively. CONCLUSION: TAMIS is an effective technique for rectal lesions, offering an acceptable short- and long-term oncological outcome for both benign and malignant lesions.

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