Comments on “Combined endoscopic submucosal dissection and transanal minimally invasive surgery for resection of large refractory rectal polyp”

I read with great interest and watched the high technical accuracy of the authors in this multimedia article “Combined endoscopic submucosal dissection and transanal minimally invasive surgery for resection of large refractory rectal polyp” [1]. This article is a great contribution, and of course, it opens the field for future combined approaches that will surely arise.

I must, nevertheless, comment on the statement that the TAMIS approach is contraindicated for anterior lesions in female patients because of the risk of development of a rectovaginal fistula. TAMIS resection of rectal tumors is a safe and feasible technique for the treatment of rectal tumors, even those located in the anterior wall, as described in many articles. In fact, one of the advantages of this approach is the possibility to treat tumors in different locations without the need to change the patient’s position, thus including anterior lesions [2].

It is true that special caution must be exercised in female patients when an anterior lesion is approached, as well as in males with previous radiotherapy or prostate procedures, but this is not a formal contraindication for the technique [3] [4].

Moreover, we must remember that TAMIS provides the possibility of full-thickness resection, as well as partial thickness resection, which may be preferable in selected patients in whom full-thickness resection is not necessary, thus avoiding the risk of complications associated with the full-thickness technique [3].

• References

• 1 Fang SH, Ngamruengphong S. Combined endoscopic submucosal dissection and transanal minimally invasive surgery for resection of large refractory rectal polyp. Endoscopy 2018; 50: 548-549
• 2 Rai V, Mishra N. Transanal approach to rectal polyps and cancer. Clin Colon Rectal Surg 2016; 29: 65-70
• 3 Martin-Perez B, Andrade-Ribeiro GD, Hunter L. et al. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 2014; 18: 775-882
• 4 Clermonts SHEM, van Loon YT, Shiphorst AHW. et al. Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results. Int J Colorectal Dis 2017; 32: 1677-1685