Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally...

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Oncology

Background:

• Limited comparative data exists on local excision quality for rectal neoplasms using transanal endoscopic microsurgery (TEMS) versus transanal minimally invasive surgery (TAMIS).
• Assessing tumor fragmentation and positive margins is crucial for evaluating excision quality.

Purpose of the Study:

• To compare the incidence of tumor fragmentation and positive margins in patients undergoing local excision of rectal neoplasms via TEMS or TAMIS.
• To evaluate the oncological outcomes and perioperative results of these two minimally invasive techniques.

Main Methods:

• Multi-institutional cohort study with coarsened exact matching.
• Inclusion of patients undergoing full-thickness local excision for benign and malignant rectal neoplasms.
• Comparison of TEMS and TAMIS interventions, measuring poor quality excision (tumor fragmentation and/or positive margin).

Main Results:

• A matched cohort of 428 patients (247 TEMS, 181 TAMIS) was analyzed.
• Poor quality excision rates were similar between TEMS (8%) and TAMIS (11%), p=0.233.
• No significant differences observed in peritoneal violation, postoperative complications, 5-year disease-free survival, or local recurrence rates.

Conclusions:

• High-quality local excision for rectal neoplasms is achievable with both TEMS and TAMIS.
• The selection of surgical platform should be guided by surgeon preference, availability, and cost.
• Both techniques demonstrate comparable oncological safety and perioperative outcomes in experienced hands.