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

Document Type : Case Report


1 Catholic University of the Sacred Hearth, Policlinico Agostino Gemelli IRCCS Rome, Italy

2 Catholic University of the Sacred Hearth, Policlinico Agostino Gemelli IRCCS Rome, Italy Ospedali Riuniti, Foggia, Italy

3 General Regional Hospital F. Miulli Acquaviva delle Fonti Italy


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.
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.
We showed for this patient the feasibility and safety of TAMIS resections at greater distances than those normally recommended.


1.       Young, D. O. & Kumar, A. S. Local Excision of Rectal Cancer. Surgical Clinics of North America (2017) doi:10.1016/j.suc.2017.01.007.
2.       Ahmed, Y. & Othman, M. EMR/ESD: Techniques, Complications, and Evidence. Current Gastroenterology Reports (2020) doi:10.1007/s11894-020-00777-z.
3.       Perivoliotis, K., Baloyiannis, I., Sarakatsianou, C. & Tzovaras, G. Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis. International Journal of Colorectal Disease (2020) doi:10.1007/s00384-020-03634-7.
4.       Lee, L. et al. Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally Invasive Surgery: A Multi-institutional Matched Analysis. Dis. Colon Rectum (2017) doi:10.1097/DCR.0000000000000884.
5.       Barendse, R. M. et al. Colorectal surgeons’ learning curve of transanal endoscopic microsurgery. Surg. Endosc. (2013) doi:10.1007/s00464-013-2931-6.
6.       McLemore, E. C. et al. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am. J. Surg. (2014) doi:10.1016/j.amjsurg.2014.01.006.
7.       Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME). Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME) (2019). doi:10.1007/978-3-030-11572-2.
8.       Lee, L. et al. Outcomes of closed versus open defects after local excision of rectal neoplasms: A multi-institutional matched analysis. Dis. Colon Rectum (2018) doi:10.1097/DCR.0000000000000962.
9.       Haugvik, S. P. et al. A critical appraisal of transanal minimally invasive surgery (TAMIS) in the treatment of rectal adenoma: a 4-year experience with 51 cases. Scand. J. Gastroenterol. (2016) doi:10.3109/00365521.2016.1157891.
10.     Hahnloser, D. et al. Transanal minimal invasive surgery for rectal lesions: Should the defect be closed? Color. Dis. (2015) doi:10.1111/codi.12866.
11.     Williams, J. G. et al. Management of the malignant colorectal polyp: ACPGBI position statement. Color. Dis. (2013) doi:10.1111/codi.12262.