title: Transanal Minimally Invasive Surgery for Local Excision of Benign and Malignant Rectal Neoplasia: Outcomes From 200 Consecutive Cases With Midterm Follow Up.
abstract: This study describes the outcomes for 200 consecutive transanal minimally invasive surgery (TAMIS) local excision (LE) for rectal neoplasia.
  
  
  
  TAMIS is an advanced transanal platform that can result in high quality LE of rectal neoplasia.
  
  
  
  Consecutive patients from July 1, 2009 to December 31, 2015 from a prospective institutional registry were analyzed. Indication for TAMIS LE was endoscopically unresectable benign lesions or histologically favorable early rectal cancers. The primary endpoints were resection quality, neoplasia recurrence, and oncologic outcomes. Kaplan-Meier survival analyses were used to describe disease-free survival (DFS) for patients with rectal adenocarcinoma that did not receive immediate salvage radical surgery.
  
  
  
  There were 200 elective TAMIS LE procedures performed in 196 patients for 90 benign and 110 malignant lesions. Overall, a 7% margin positivity and 5% fragmentation rate was observed. The mean operative time for TAMIS was 69.5 minutes (SD 37.9). Postoperative morbidity was recorded in 11% of patients, with hemorrhage (9%), urinary retention (4%), and scrotal or subcutaneous emphysema (3%) being the most common. The mean follow up was 14.4 months (SD 17.4). Local recurrence occurred in 6%, and distant organ metastasis was noted in 2%. Mean time to local recurrence for malignancy was 16.9 months (SD 13.2). Cumulative DFS for patients with rectal adenocarcinoma was 96%, 93%, and 84% at 1-, 2-, and 3-years.
  
  
  
  For carefully selected patients, TAMIS for local excision of rectal neoplasia is a valid option with low morbidity that maintains the advantages of organ preservation.
authors.affiliation: Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.forename: Teresa
authors.initials: T
authors.lastname: deBeche-Adams
authors.forename: George
authors.initials: G
authors.lastname: Nassif
authors.forename: Beatriz
authors.initials: B
authors.lastname: Martin-Perez
authors.forename: John R T
authors.initials: JRT
authors.lastname: Monson
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Albert
authors.forename: Sam B
authors.initials: SB
authors.lastname: Atallah
mesh_terms: D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D061646:Operative Time; D011351:Proctoscopy; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome