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Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour

Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-ye...

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Autores principales: Wachter, Nicolas, Wörns, Marcus-Alexander, dos Santos, Daniel Pinto, Lang, Hauke, Huber, Tobias, Kneist, Werner
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916761/
https://www.ncbi.nlm.nih.gov/pubmed/27279406
http://dx.doi.org/10.4103/0972-9941.181306
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author Wachter, Nicolas
Wörns, Marcus-Alexander
dos Santos, Daniel Pinto
Lang, Hauke
Huber, Tobias
Kneist, Werner
author_facet Wachter, Nicolas
Wörns, Marcus-Alexander
dos Santos, Daniel Pinto
Lang, Hauke
Huber, Tobias
Kneist, Werner
author_sort Wachter, Nicolas
collection PubMed
description Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR). The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS) in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs.
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spelling pubmed-49167612016-07-05 Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour Wachter, Nicolas Wörns, Marcus-Alexander dos Santos, Daniel Pinto Lang, Hauke Huber, Tobias Kneist, Werner J Minim Access Surg Unusual Case Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR). The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS) in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4916761/ /pubmed/27279406 http://dx.doi.org/10.4103/0972-9941.181306 Text en Copyright: © 2016 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Unusual Case
Wachter, Nicolas
Wörns, Marcus-Alexander
dos Santos, Daniel Pinto
Lang, Hauke
Huber, Tobias
Kneist, Werner
Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title_full Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title_fullStr Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title_full_unstemmed Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title_short Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour
title_sort transanal minimally invasive surgery (tamis) approach for large juxta-anal gastrointestinal stromal tumour
topic Unusual Case
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916761/
https://www.ncbi.nlm.nih.gov/pubmed/27279406
http://dx.doi.org/10.4103/0972-9941.181306
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