Transanal minimally invasive surgery (TAMIS) is a surgical alternative to proctectomy in the management of complex rectal polyps and early rectal cancers. In 2016, our institution introduced a TAMIS programme. The purpose of this study was to evaluate changes in practice and outcomes in our institution in the 3 years before and after the implementation of TAMIS. We conducted a retrospective analysis of a prospective database of patients who underwent proctectomy or TAMIS for the management of complex rectal polyps or early rectal cancers at our institution between 2013 and 2018. 96 patients were included in this study (41 proctectomy vs 55 TAMIS). A significant reduction was noted in the number of proctectomies performed in the 3 years after the implementation of TAMIS as compared to the 3 years before (13 vs 28) (P < 0.001); 43% of patients (n = 12) who underwent proctectomy in the period prior to implementation of TAMIS were American Society of Anaesthesiologists grade III, as compared to only 15% (n = 2) of patients during the period following TAMIS implementation (P = 0.02). TAMIS was associated with a significant reduction in length of inpatient stay (P < 0.001). Oncological outcomes were comparable between groups (log rank P = 0.83). Our findings support TAMIS as a safe and effective alternative to radical resection. The availability of TAMIS has resulted in a significant reduction in the number of comorbid patients undergoing proctectomy at our institution. Consequently, we have observed a significant reduction in postoperative complications over this time period.

中文翻译：

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在三级转诊直肠癌中心实施经肛门微创手术局部切除早期直肠肿瘤对结果的影响。

经肛门微创手术 (TAMIS) 是治疗复杂直肠息肉和早期直肠癌的直肠切除术的替代手术。 2016 年，我们机构推出了 TAMIS 计划。本研究的目的是评估我们机构在实施 TAMIS 前后 3 年中实践和结果的变化。我们对 2013 年至 2018 年间在我们机构接受直肠切除术或 TAMIS 治疗复杂直肠息肉或早期直肠癌的患者的前瞻性数据库进行了回顾性分析。本研究纳入了 96 名患者（41 名直肠切除术 vs 55 名 TAMIS）。与前 3 年相比，实施 TAMIS 后 3 年实施的直肠切除术数量显着减少（13 例 vs 28 例）（P < 0.001）；在 TAMIS 实施之前接受直肠切除术的患者中，有 43% (n = 12) 为美国麻醉医师协会 III 级，而在 TAMIS 实施后，这一比例仅为 15% (n = 2) (P = 0.02）。 TAMIS 与住院时间显着缩短相关 (P < 0.001)。各组之间的肿瘤学结果具有可比性（对数等级 P = 0.83）。我们的研究结果支持 TAMIS 作为根治性切除术的安全有效的替代方案。 TAMIS 的推出使我们机构接受直肠切除术的合并症患者数量显着减少。因此，我们观察到在此期间术后并发症显着减少。