V34 - Laparoscopic Transanal Minimally Invasive Surgery (TAMIS) for Resection of Rectal Wall Recurrence of Renal Cell Carcinoma

Purpose/Background: Renal cell carcinoma (RCC) is the most common adult kidney malignancy, with clear cell histology representing the predominant subtype. Approximately 30 percent of patients present with metastatic disease. Common metastatic sites include the lungs, bones, liver, brain, and regional lymph nodes, whereas rectal metastasis is exceedingly rare with only a few reported cases. When present, rectal metastases often manifest as hematochezia due to the tumor's hypervascularity.

Methods/Interventions: We present a video demonstration of a 63 year old male with a history of right sided clear cell RCC treated with nephrectomy and IVC thrombectomy (pT3bN0). Preoperative imaging revealed a 1.6 cm lesion within the anterior rectal wall abutting the rectoprostatic fascia, suspicious for either a primary rectal neoplasm or metastasis. The patient was asymptomatic at presentation. The lesion was easily palpable, firm, and slightly mobile in the anterior rectal wall on digital rectal examination. Given the limited local disease, a transanal minimally invasive surgery (TAMIS) approach was selected for resection to minimize postoperative morbidity.

Results/Outcomes: The patient was placed in lithotomy and a GelPoint Path Transanal Platform was used to establish pneumorectum at 15 mmHg. A longitudinal incision was made distal to the lesion, extended circumferentially in an elliptical fashion, and carried through the mucosa, submucosa, and muscularis propria to achieve a full thickness excision. The specimen was retrieved en bloc, and the defect was closed primarily in a linear fashion using 3-0 PDS suture using silver anchors to reduce the risk of stricture formation. Pathologic evaluation confirmed metastatic clear cell RCC with negative margins. The patient was discharged the same day without complications and subsequently continued systemic immunotherapy. Follow up imaging demonstrated no evidence of residual or recurrent disease. The patient maintains normal bowel function with no hematochezia, pain, or incontinence.

Conclusion/Discussion: This case highlights the feasibility and safety of using TAMIS for local excision of isolated rectal metastases from RCC. Although metastatic RCC to the rectum is exceedingly rare, TAMIS offers excellent visualization, precise dissection, and primary closure with low postoperative morbidity. This minimally invasive transanal approach may serve as an effective organ preserving option in select patients with limited metastatic disease amenable to local resection.