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The surgical treatment of rectal cancer, the final part of the colon, has changed radically in recent years and, with the help of biotechnology and the understanding of the biological behavior of the disease, continues to change.

The international scientific community of surgeons, oncologists, pathologists and molecular biologists who deal with this cancer is constantly faced with new data.

The surgery of the organ differs from the surgery of other parts of the colon and is particularly demanding.

Furthermore, in many cases, the removal of the rectum is accompanied, in addition to the usual surgical complications, by special complications and consequences that affect the patient’s quality of life and concern serious disorders of defecation and urination, as well as sexual disorders.

In relatively advanced tumors, with the introduction of preoperative chemotherapy and radiotherapy, in various regimens, in a large and constantly increasing percentage, currently reaching 20%, clinical, radiological and endoscopic cure is observed, that is, the tumor disappears completely. In these patients we can apply the tactic of waiting and close monitoring (watch and wait) for any recurrence of the disease. In case of recurrence, the “delayed” standard surgery offers the same high cure rates, as if it were performed initially! Which patients will relapse has not yet been fully clarified.

It is certain, however, that in a significant percentage, reaching 10%, with some particular biological characteristics (such as tumors with microsatellite instability, MSI positive tumors), we will have a complete and permanent cure, especially if we know in advance the biological characteristics of the tumor and apply the appropriate treatment.

However, in cases of cancers located in the rectal mucosa, or even in those that do not occupy the entire muscular layer of the organ, preoperative radiochemotherapy is not indicated.

Until recently, these tumors were treated with the standard rectal resection operation.

Technological advances have made it easier and safer to perform local resection of a part of the rectum that includes the entire intestinal wall, with the tumor, as well as part of the surrounding fibrofatty tissue, called the mesorectum. The same technique is also used to remove other tumors, such as neuroendocrine tumors. This method is also used to treat elderly patients and patients with serious health problems who cannot undergo a major operation.

Minimally invasive transanal resection (TAMIS)

This technique, which is an evolution of other transanal resections, is called transanal minimally invasive surgery – TAMIS and can be performed with laparoscopic surgery equipment or with the use of the Da Vinci robotic system, which allows us to perform safer and more difficult resections. It has become possible to save the organ and the sphincter mechanism with these techniques, which leads to a better quality of life. Of course, the use of a special work platform, the TAMIS platform, is essential.

At the Interbalkan Medical Center of Thessaloniki, there is the required excellent cutting-edge technology, as well as high-level scientists, surgeons, oncologists, and radiation therapists who collaborate even for these cases in which there are reasons to preserve the rectum. Specific treatment and monitoring protocols are followed for these patients, whether they belong to the group of complete response to preoperative radiochemotherapy, or are diagnosed with non-advanced tumors and transanal removal of the lesion is applied to them.

Advantages of the TAMIS technique

The TAMIS technique, endoscopic or robotic, offers rapid recovery and is accompanied by excellent functional and in many cases oncological results. The patient is discharged from the hospital in 2 to 3 days, without the excruciating symptoms and disabilities of a total low rectal resection.

Of course, proper patient selection is the key to good results.