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Erkan et al. Mini-invasive Surg 2018;2:30 I http://dx.doi.org/10.20517/2574-1225.2018.51 Page 7 of 10

Figure 5. A T2 rectal tumor specimen fixed on board after transanal minimally invasive surgery excision

months after the surgery. They did not note any deterioration, but a general improvement in QoL and more
specifically in FISI scores after TAMIS.

[43]
Schiphorst et al. similarly reported FISI scores of 35 patients pre- and post-TAMIS. Their data showed
that 3 of 18 patients with normal continence developed soiling after the surgery but 2 of them returned to
normal in 6 months. Fifteen of 17 patients with abnormal FISI score showed improvement in fecal conti-
nence following TAMIS.

These studies yield varying results. It should be kept in mind that one of these studies compared TAMIS
patients to healthy control group, and the other two compared the same patients’ pre- and post-operative
status. A study comparing functional outcomes and QoL of patients who underwent TAMIS versus TME
would give a more meaningful picture in terms of the functional benefits of local excision over radical re-
section.

COMPLICATIONS
[29]
Lee et al. reported postoperative morbidity of TAMIS to be 9% in a series of 228 patients comprising
both benign and malignant tumors. In another study by the same group, complication rates of TAMIS in
a group of 110 rectal cancer patients was 15%. The most common complications of TAMIS were urinary
[30]
retention, perioperative bleeding and peritoneal violation; similar to TAE and TEM .

Both urinary retention and peritoneal entry have been associated with anterior and lateral location of the
tumor. Urinary retention is usually self-limited and treated by temporary urinary catheterization. Entry
into peritoneal cavity has been reported more frequently with upper lesion location (> 8-10 cm from anal
verge). The largest TAMIS series published to date had an incidence of peritoneal entry of only 2%. In con-
trast, the incidence is reported as 6%-8.6% for TEM. Either transanal or laparoscopic suturing can be uti-
lized when a peritoneal defect occurs. It is not associated with increased morbidity. Risk is further reduced
in the setting of preoperative bowel preparation and intravenous antibiotic treatment for 24 h postopera-
tively [18,19,44] . In these patients, a gastrograffin enema is recommended on postoperative day 3 to document
[2]
the absence of a leak .
[30]
Mean blood loss for local excision of rectal cancer is 28 mL . Increased bleeding has been associated with
large tumor size. Cases of post-procedural hemorrhage that do not stop spontaneously have in all cases
[1]
been managed successfully either endoscopically or with examination under anesthesia and sewing .
Less commonly reported complications include urinary tract infection, subcutaneous emphysema, scrotal