title: [Hybrid TAMIS total mesorectal excision. A new perspective in treatment of distal rectal cancer - Technique and results].
abstract: BACKGROUND
  Transanal minimally invasive surgery (TAMIS) represents a promising technique for total mesorectal excision (TME) with respect to radicalness and preservation of function. There are only few publications in the literature describing results in patients with distal rectal cancer.
  
  
  METHODS
  Between May 2013 and March 2015, 24 selected patients with a rectal carcinoma < 6 cm from the anal verge underwent a laparoscopically assisted TAMIS TME (Hybrid-TAMIS TME) procedure. This prospective observational study was conducted to examine the safety of the technique and the quality of TME surgery in distal rectal cancer and to assess the short-term postoperative outcome.
  
  
  RESULTS
  The median age of patients (18 male and 6 female) at the time of surgery was 57 years (range 35-77 years) and 7 patients (29 %) had a body mass index (BMI) > 30 kg/m(2). Specimen excision was carried out transanally in 19 patients. Pathological grading of TME specimens was good in 22 (92 %) and moderate in 2 cases. After neoadjuvant radiochemotherapy a complete pathological remission was identified in five patients. The median distal resection margin was 7 mm (range 2-30 mm), the median circumferential resection margin was 6 mm (range <1 mm-30 mm) and in 2 patients the tumor was ≤ 1 mm from the positive circumferential margin. A colonic reservoir was created in 19 patients (79 %) and no 30-day mortalities occurred. Morbidity was 29 %, including 1 anastomotic leak, 2 hematomas and 1 neurogenic bladder.
  
  
  CONCLUSIONS
  Hybrid-TAMIS TME for distal rectal cancer is safe and can provide a sphincter-preserving high-quality TME in difficult cases. Studies with long-term follow-up assessing oncological and functional results are mandatory.
authors.affiliation: Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Leverkusen, Leverkusen, Deutschland.
authors.forename: A D
authors.initials: AD
authors.lastname: Rink
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
authors.forename: D W
authors.initials: DW
authors.lastname: Kauff
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Paschold
authors.affiliation: Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Leverkusen, Leverkusen, Deutschland.
authors.forename: K-H
authors.initials: KH
authors.lastname: Vestweber
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland. werner.kneist@unimedizin-mainz.de.
authors.forename: W
authors.initials: W
authors.lastname: Kneist
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D039021:Colonic Pouches; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
keywords: Minimally invasive surgery; Operation; Radicalness; Safety margin; Sphincter preservation