Ribas Y, Hotouras A, Wexner SD, D'Hoore A

“In recent years, the use of local excision has increased in an attempt to reduce the risk of morbidity associated with anterior resection. Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) have been incorporated into the surgical armamentarium. Indications for TEM include T1N0 rectal cancer with low-risk histopathological features, but there are reports of T2N0 tumours treated with TEM after chemoradiotherapy resulting in a high pathological complete response and negative resection margins, although long-term oncological results are awaited.

Nevertheless, a word of caution should be raised regarding adequate patient selection. Local excision is considered an acceptable approach when the risk of mesorectal lymph node metastases is low, and therefore preoperative staging is of crucial importance to select the optimal treatment pathway. The key point is to reliably identify tumours that would be suitable for local excision avoiding the risks of patients being undertreated.”

---

Burke JP, Albert M

“Based on current available clinical data, TAMIS in experienced hands results in the quality local excision of rectal lesions with low histological margin positivity in an efficient manner with an equivalent morbidity profile. Long-term oncologic data for TAMIS is not yet available, but because of its similarities to TES, it is expected to be similar. TAMIS might have a shorter learning curve compared to rigid TES platforms and does not have the barrier of a high upfront cost. This has the potential to increase the number of surgeons and institutions who could offer the benefits of transanal endoscopic surgery to their patients.”

---

Maglio R, Muzi GM, Massimo MM, Masoni L

“TAMIS is a technique with great potential. … It is a versatile platform that offers colorectal surgeons the ability to approach diseases of the rectum with a different perspective. It has a much broader application than for local excision of rectal neoplasia, and the role for TAMIS beyond local excision is likely to expand as surgeons become more experienced with this emerging technique. Careful patient selection and evaluation of long-term outcomes have to be made before it can replace TEM.”

---

Schiphorst AH, Langenhoff BS, Maring I, Pronk A, Zimmerman DD

“Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment. More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance.”

---

Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S

“TAMIS is a new transanal platform for [local excision] and for applications beyond [local excision]. In this inclusive, 4-year review of available clinical data on TAMIS, it is shown that early results are encouraging and that this new approach to transanal surgery is undergoing significant global growth.”

---

Marks JH, Reynolds H

“By combining local excision techniques and chemoradiation, the problem of persistent disease from untreated lymphatics is addressed. In higher lesions, TEM/TAMIS helps address the problem of specimen fragmentation and the challenge of achieving clear margins by operating with an endoluminal approach. With the combination of these approaches, the patient has an increased chance for success with an expanded role of local therapy for stage I rectal cancer. The challenge that persists, unfortunately, remains to better stage rectal cancers, so we can clearly identify those that have no lymphatic involvement. With more reliable information on staging in hand, we would have the technical ability with TEM and TAMIS to treat cancers in the upper rectum itself. Unquestionably, the future will see wider application of these techniques as additional work with these multidisciplinary, minimally invasive approaches to rectal cancer progresses.”

---

Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW

“Transanal minimally invasive surgery is an advanced transanal platform that provides a safe and effective method for resecting benign neoplasms, as well as carefully selected early-stage malignancies of the mid and distal rectum.”

---

Morino M, Allaix ME

“In 2013, TEM is the safest and most effective treatment modality available for large rectal adenomas, with significantly higher complete resection rates and lower local recurrence rates than conventional transanal excision.”

---

Atallah S, Albert M, Debeche-Adams T, Larach S

“TAMIS is a versatile platform which offers colorectal surgeons the ability to approach disease of the rectum with a different perspective. It has a much broader application then for local excision of rectal neoplasia, and the role for TAMIS beyond local excision is likely to expand as surgeons become more experienced with this emerging technique.”

---

Guerrieri M, Baldarelli M, Rimini M, Gesuita R, Lezoche G, Romiti C, Lezoche E

“TEM is safe and effective for rectal adenomas not removable endoscopically. T1 cancer may undergo local excision alone, while T2 and T3 lesions require preoperative radiochemotherapy. The results reported seems to be not very different in terms of local recurrence and survival rate to those after conventional surgery.”

---