Transanal excision of rectal tumors by endoscopic microsurgery using SILS® equipment

Seance of wednesday 17 june 2015 (ÉVALUATION CRITIQUE DES PRATIQUES EN CHIRURGIE LAPAROSCOPIQUE : SÉANCE COMMUNE AVEC LE CLUB CŒLIO)

Abstract

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® 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® port is workable and reproducible, with no mortality, little morbidity, and macroscopic quality excision.