Transanal minimally invasive surgery (TAMIS) for anterior rectal GIST

Excerpt

The incidence of gut gastrointestinal stromal tumors (GISTs) is less than 1%, 90% found in the stomach or small intestine, and only 3% are located in the rectum. Treatment of rectal GISTs needs careful planning in order to preserve the rectum and sphincters where possible. Neoadjuvant therapy has extended the indications for local excisions [1]. Several approaches for local, sphincter-preserving resection of GISTs have been described. The transanal (Parks) and transsacral (Kraske) techniques can achieve a complete resection in low- and mid-rectal lesions with low morbidity and mortality but usually require fragmentation of the specimen with an increased risk of local recurrence [2]. Anteriorly located GISTs are particularly challenging. Transvaginal excision has been described for high anterior rectal wall lesions, with the advantage of avoiding anal dysfunction [3]. Another method is the perineal approach, which has been implemented for GISTs on the anterior rectal wall [4]. More recently, transanal minimally invasive endoscopic excision has been described. This includes transanal minimally invasive surgery (TAMIS), transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) [5]. Advantages of these techniques are that clear resection margins and intact specimens produced may lead to improved outcomes. …