Transanal excision of rectal tumors by endoscopic microsurgery using SILS (R) equipment

Objectives: The aim of the study is to evaluate the feasibility, the morbidity and the efficacy of transanal excision by endoscopic microinvasive surgery using the SILS (R) port for the treatment of rectal tumors. Methods: From January 2010 to December 2013, 94 patients had a transanal excision of a benign rectal lesion (n=72) or malignant tumor (n=22). The mean diameter of the lesions was 2,9 mm +/- 1,2 (1-7) and the mean height compared to the anal margin was 7,5 cm +/- 3,5 (4-10). Results: The mean operating time was 52,3 min +/- 28,6. There were 2 conversions (2,1 %) for intraperitoneal perforation, one needing proctectomy with total mesorectal excision (TME). Mortality was nil and morbidity was 14,7 %, with 22 patients Clavien 1-2 and 4 patients Clavien 3. Mean hospital stay was 3 days +/- 3. Excision was complete by histological confirmation in 84 cases (89,4 %). With an average follow-up of 39,2 months +/- 15, the rate of local recurrence in case of benign lesion was 7 % (n=5). One patient was reoperated to have a proctectomy with TME, the 4 others had another transanal excision. In case of malignant tumor, recurrence rate was 6,2 % (1 patient). It was a lesion T1sm1 that was reoperated by transanal endoscopy. Conclusion: Transanal endoscopic excision of rectal tumors with the SILS (R) port is workable and reproducible, with no mortality, little morbidity, and macroscopic quality excision.