Minimally invasive transgery for early cancer in the upper rectum for cure and a better quality of life

Minimally invasive transanal surgry (MITAS) was performed for early cancer without massive invasion into the submucosal layer in the upper rectum, which is not suitable for endoscopic or conventional transanal excision. Twenty-eight patients underwent MITAS for 29 rectal tumors (mucosal cancer 17, slight submucosal invasion 6, moderate submucosal invasion 5, massive submucosal invasion 1). The mean maximum diameter of the tumors was 26 mm, and the mean distance from the anal verge to the proximal margin of the tumor was 9.2 cm. Sixty-six percent of the tumors were located above the peritoneal reflection. Shortening and invagination of the rectum was initially performed using the E type anal retractor. The tumor was excised and simultanous anastomosis by a stapler following stiching under the tumor for pulling out the tumor. The mean operative time and blood loss were 23 minutes and 21 g respectively. There was no mortality or morbidity except one case of transient bleeding. Oral intake was started the day following the operation. The mean discharge day was about 5 days after the operation. The longest follow up was 3 years and 8 months. There was one recurrence, which was only surgical margin positive, and it was reexcised by MITAS. No further recurrent cases have been observed so far including the reexcised case. MITAS was considered to be a minimally invasive local excision procedure for cure and a better quality of life.