EP 523 Minimally Invasive Transanal Excision Techniques for Rectal Neoplasms: A Retrospective Audit

Abstract Aim Minimally invasive techniques for local excision of rectal neoplasms, such as transanal minimally invasive surgery (TAMIS) and transanal resection of tumour (TART), have become increasingly common for treating benign polyps and early-stage (T1) lesions in the mid and lower rectum. This audit reviews the outcomes of these procedures at our institution. Methods This retrospective audit included all patients aged 16 years and older, who underwent transanal excision of rectal neoplasms at our institution from January 2019 to December 2022. Results Thirty-eight patients were included (TART 24 - 63.1%; TAMIS 14 - 36.8%), with a female predominance (55%). Neoplasms were primarily detected via colonoscopy or flexible sigmoidoscopy (94.7%), with CT colonography and rectal MRI in 26.3% and 21%, respectively. Most lesions (81.5%) were in the lower rectum; the remainder were in the anal canal. Histology showed tubulovillous adenoma with low-grade dysplasia in 60.5%, TVA with LGD and focal HGD in 7.9%, TVA with HGD in 5.2%, serrated adenoma with LGD in 10.5%, malignancy in 2.6%, and anal intraepithelial neoplasia in 5.2%. Conclusions The transanal approach to rectal neoplasms, including TAMIS, provides significant benefits such as organ preservation and reduced morbidity. With the rising incidence of early rectal cancers and the risks associated with total mesorectal excision, minimally invasive transanal techniques represent a safe and effective alternative. Ongoing clinical trials continue to evaluate their long-term oncological outcomes.