TAMIS for Recurrent Cancer of the High Rectum (25 cm from the Anal Verge) in a Patient with Serious Associated Disorders (Rescue Surgery)

Transanal Minimally Invasive Surgery (TAMIS) is indicated for benign lesions of the rectum (≤3 cm and not >1/3 of rectal circumference), early-stage malignancies confined to the submucosa (T1 Sm1 on Kikuchi classification), neoplasms after an incomplete response to neoadjuvant treatment or with T1 residue, and T2-T3 N0 cancers in patients who cannot undergo major surgical resections (rescue surgery). TAMIS is especially recommended for neoplasms located at a distance of 5-18 cm from the anal verge. Case Presentation: We performed TAMIS on a 72-year-old patient with multiple morbidities diagnosed with diffuse polyposis syndrome, with a history of multiple recurrences treated with surgical resections, and with a new recurrence on the ileorectal anastomosis at about 25 cm from the anal verge. A rectoscopy and a total body computerized tomography were performed (anastomotic level; size 2 cm; staging: cT1-2, N0, M0; histology: adenocarcinoma). The final decision after a multidisciplinary meeting was for TAMIS, due to high intra- and post-operative risks contraindicating major surgery. Data regarding total operating time, blood loss, length of stay, surgical and general intra- and post-operative complications, resumption of nutrition, and medications were collected. The operation was successful, with a total operating time of 55 minutes and an estimated blood loss of 20 ml. The patient was rapidly mobilized and nutrition was promptly resumed. The hospital stay was 3 days. No complications were observed. Conclusion: In this case, we showed the feasibility and safety of the TAMIS resection at a greater distance than that normally recommended.