Muneeb Ul Haq

Background: Transanal minimally invasive surgery (TAMIS) is used for local excision of selected benign and early malignant rectal lesions but operating within the confined pelvic space can be technically demanding. This study describes the early UK experience of single-port (SP) robotic TAMIS using a dedicated access port. Methods: Consecutive patients undergoing SP robotic TAMIS (SP R-TAMIS) at a single UK tertiary centre between September 2025 and March 2026 were prospectively included. All cases were reviewed by a specialist small early rectal cancer multidisciplinary team. The primary outcomes were completion using the SP platform without conversion and 30-day morbidity. Results: A total of 18 patients underwent SP R-TAMIS for benign or non-invasive ( n = 10) and malignant ( n = 8) rectal lesions. Lesions were located 1–20 cm from the anal verge. All procedures were completed without conversion or re-docking. En bloc resection was achieved in 16(89%) cases, and all malignant lesions had clear (R0) margins. Median operative time was 55 min (interquartile range [IQR] 48.5–83.0). All patients were discharged within 23 h. One patient was readmitted with delayed bleeding and was managed conservatively. The 3-month functional data were available for 14 patients; no major low anterior resection syndrome (LARS) was recorded amongst patients with available early follow-up. Conclusions: SP R-TAMIS using a dedicated access platform was technically feasible in this carefully selected, single-centre cohort. The small sample, single-surgeon design, absence of a comparator and short follow-up preclude conclusions about its superiority, long-term oncological safety and functional benefit over other established endoscopic and surgical approaches. Further comparative evaluation is needed, incorporating longer oncological and functional follow-up and formal health-economic assessment.

Background: Minimally invasive techniques are the standard of care in colorectal surgery. However, high body mass index (BMI) presents technical and anaesthetic challenges. Robotic-assisted surgery offers potential advantages in this population; however, given its relatively recent adoption, outcome data remain limited. This article presents a single-centre case series evaluating the short-term surgical and anaesthetic outcomes of obese patients undergoing robotic colorectal resections. Methods: A retrospective review was performed of patients with BMI > 30 kg/m ² who underwent robotic colorectal cancer resection at Liverpool University Hospital NHS Trust between July 2019 and April 2024. Demographic, surgical, anaesthetic, and clinical outcome data were collected from a prospectively maintained database. Key measures included operative time, Trendelenburg positioning, critical care admissions, complications, and mortality. Results: Seventy-five patients [mean BMI 35.8 (range 30.0–66.1) kg/m ² ] underwent robotic resection. Conversion to open surgery occurred in one case (1.3%). Mean operative time was 380 min for rectal and 289 min for colonic resections. The average Trendelenburg tilt was 20 ^o (range 15–22), with an average lateral tilt of 15 ^o (range 10–20), and mean head down duration was 225 (range 120–320) min. Fifty-six (74.7%) patients had primary anastomosis; the anastomotic leak rate was 9.3%. Thirty-two per cent of patients were electively admitted to the critical care as part of our institutional pathway for high BMI-cases. Of these, three patients (4.0%) required overnight mechanical ventilation and were both extubated the following morning without further organ support. One case of postoperative visual disturbance, attributed to positioning, resolved fully. The 30- and 90-day mortality rate was 1.3%. Conclusion: Robotic colorectal surgery is a feasible and safe option in elevated BMI patients, with low conversion rates and acceptable morbidity. Importantly, prolonged Trendelenburg position did not appear to increase anaesthetic risk, with only one reversible positioning-related complication observed.

Background/Objectives: With recent advancements in rectal cancer management leading to longer patient survival, the impact of various treatment approaches on patients’ quality of life (QOL) becomes an important focus of attention. While QOL studies exist for watch-and-wait after (chemo)radiation with/without local excision, data on health-related QOL (HRQOL) outcomes after contact X-ray brachytherapy (CXB) remain limited. This study evaluated functional and HRQOL outcomes in rectal cancer patients undergoing CXB and (chemo)radiation over one year. Methods: This prospective observational study (enrolment January–October 2023) with one-year follow-up assessed functional and HRQOL outcomes after CXB and (chemo)radiation using EORTC-QLQ-CR29, HADS, and EQ-5D-3L questionnaires. Longitudinal analyses were conducted using linear mixed-effects models, incorporating both fixed and random effects, following data processing based on relevant scoring manuals. Results: QOL was assessed in 53 patients who attended our centre for CXB for various clinical indications, with 51, 47, and 42 remaining at the end of treatment, 6-month, and 12-month follow-ups, respectively. Overall, symptom and functional scores from EORTC-QLQ-CR29 remained stable throughout the follow-up period. Significant improvements were observed in abdominal pain, flatulence, urinary frequency, and body weight at 12 months. HADS and EQ-5D-3L scores remained stable, while EQ-VAS scores showed improvement, indicating a good overall quality of life following CXB treatment. Conclusions: CXB treatment combined with (chemo)radiation maintained stable HRQOL, with some improvements in symptoms and QOL noted during the subsequent year. These findings will help rectal cancer patients understand the benefits and limitations of CXB as a treatment option.

Background: Currently, there are no clinically predictive models that can prognosticate the response of rectal cancers to Contact X‐ray brachytherapy (CXB). This review aims to critically evaluate existing models that have attempted to predict the response of rectal cancer to external beam radiotherapy, with the objective of laying the foundation for the development of a CXB‐specific prediction model.Methods: A random‐effects meta‐analysis was employed to calculate pooled estimates of the discriminative ability of published models. Using the Prediction Model Risk Of Bias Assessment Tool (PROBAST), each model was evaluated for its risk of bias and applicability. Additionally, the frequency of commonly utilised predictive factors was documented.Results: Twelve papers discussed fifteen models based on pre‐treatment factors. Models predicting response based on the Tumour regression grade (TRG) classified responders as patients who achieved a complete response or near complete response and achieved a pooled AUC of 0.82 (95% CI 0.74–0.89). Models that predicted pathologic complete response (pCR) had a pooled AUC of 0.76 (95% CI 0.71–0.82). The most utilised predictive parameters were age, tumour grade and T stage. However, these models were prone to significant risk of bias and had limited applicability to the general population.Conclusions: Although the existing models were statistically robust, they lacked broad applicability. This was primarily due to a lack of external validation, which limits their clinical utility. A future CXB‐specific model should prioritise dedicated data collection based on pre‐calculated sample size and include the predictive factors identified in this review.