Transanal Minimally Invasive Surgery (TAMIS) for Rectal Lesions: A Systematic Review.

BACKGROUND/AIMS: Transanal minimally invasive surgery (TAMIS) has received attention as an alternative to transanal endoscopic microsurgery for rectal lesions. We review the effectiveness and safety of TAMIS for the treatment of rectal lesions. METHODOLOGY: The MEDLINE, Web of Science, and Cochrane Library databases were searched using predefined inclusion criteria. The primary outcomes were positive margin rate, recurrence rate, conversion rate, range of applications, and complication rates. To derive pooled estimates of proportions with 95% Confidence Interval (CI) for the outcomes, a random effect model was used. RESULTS: Twelve studies including 155 patients were identified. The weighted mean size of rectal lesions was 3.3 cm (range 0.2-10 cm) and the weighted mean distance from the anal verge was 7.4 cm (range 0-20 cm). Six studies enrolled only the patients with low and mid rectal lesions mainly to avoid peritoneal entrance during excision. CONCLUSIONS: Based on the evidence from this limited number of studies, TAMIS appears to be an effective and safe treatment for rec tal lesions. However, the clinical outcome of TAMIS according to the location of the rectal lesions needs to be clarified. Comparison with other established surgical treatments are also mandatory.

Role of regular follow-up after curative surgery for colorectal cancer.

BACKGROUND/AIMS: This investigation aimed to estimate the value of regular follow-up programs after curative resection for colorectal cancer. METHODOLOGY: We compared the recurrence rate, rate of curative re-resection, and survival rate between groups who had either regular or irregular follow-up. The medical records of 397 consecutive patients, who underwent a curative resection for colorectal cancer between January 1994 and December 1997, were analyzed retrospectively. RESULTS: The recurrence rate was 19.4% and 20.8% in the regular and irregular follow-up groups (P > 0.05), respectively. There was a significant difference in the asymptomatic recurrence rate (62.9 vs. 18.7%; P = 0.021), but curative re-resection was possible in 18 (29.0%) of those patients with cancer recurrence in the regular follow-up group, and in 2 (12.5%) in the irregular follow-up group, which was not significantly different (P > 0.05). 5-year survival rate between the groups was not significantly different (78.1 vs. 61.2%; P > 0.05). CONCLUSIONS: A regular follow-up program after a curative resection for colorectal cancer, although facilitating detection of recurrence before symptoms developed, was unlikely to succeed in increasing the rate of a curative intent re-resection and survival remarkably.