Transanal Minimally Invasive Surgery for Anterior Low Rectal Cancer after Chemoradiation

Web-Exclusive Content: Didactic Video Collection Transanal Minimally Invasive Surgery for Anterior Low Rectal Cancer After Chemoradiation Montagna, Marco M.D.; Verbo, Alessandro M.D.; Casella, Annachiara M.D. Author Information Diseases of the Colon & Rectum 64(1):p e6, January 2021. | DOI: 10.1097/DCR.0000000000001879 Denotes Video Featured on DCR YouTube Channel Denotes X (Twitter) Account Access TEACHING POINTS Patient preparation: Complete bowel preparation was performed the day before surgery. Perioperative antibiotics were given. Deep vein thrombosis prophylaxis was performed. Patient position: Prone jack knife position because the lesion is located on the anterior rectal wall. Critical steps: Perimeter tracking for margin-free resection. Margin-free (R0) full-thickness local excision. Complete wound suture. Potential areas of injury: Injury of prostatic capsule, pararectal abscess, intraperitoneal perforation, and bleeding. VIDEO SUMMARY In this video, we show a local excision by transanal minimally invasive surgery (TAMIS) for residual rectal adenocarcinoma, after preoperative long-course chemoradiation, located on the anterior wall, performed on an 83-year-old man with severe comorbidities. The choice to perform TAMIS was secondary to the downstaging after chemoradiation and to the comorbidities of the patient, because he was considered unfit for major surgery with total mesorectal excision by the local multidisciplinary team. The patient was discharged 2 days after surgery without complications. The result of the final histological examination was pT1.