Fecal incontinence after transanal endoscopic microsurgery

Jakubauskas, Matas; Jotautas, Valdemaras; Poškus, Eligijus; Mikalauskas, Saulius; Valeikaite-Tauginiene, Gintare; Strupas, Kęstutis; Poškus, Tomas

doi:10.1007/s00384-018-2983-0

Cited by 16 publications

(18 citation statements)

References 27 publications

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“…The study concluded that TEM has significant rate of fecal incontinence that impairs quality of life. In comparison to laparoscopic low anterior resections which have reported Wexner scores of 5.2 ± 4.2 at 6 months postoperatively, and scores of 3.7 ± 3.4 at 12 months, the Wexner scores were similar for TEM [40] . TEM, however, still results in much lower fecal incontinence than open surgery which has reported Wexner scores as high as 14.2 at 6 months and 10.3 at 12 months after surgery [36] .…”

Section: Robotic Surgery For Rectal Cancermentioning

confidence: 62%

“…They studied 93 patients who had undergone TEM for benign rectal lesions or T1N0 rectal cancer and found that the Wexner incontinence scale (range 0-10) was increased from baseline at 3 months, began to decline at 12 months and returned to baseline preoperative value at 60 months [39] . Another single center study was conducted in which a EuroQol (EQ-5D-5L) quality of life questionnaire and a Wexner fecal incontinence scale was given to 132 patients who underwent TEM for a variety of rectal lesions including adenocarcinoma with a median follow-up period of 96 months [40] . Those considered to have minor to no fecal incontinence were rated as having a Wexner score of 2 or less.…”

Section: Robotic Surgery For Rectal Cancermentioning

confidence: 99%

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Quality of life after minimally invasive surgery for rectal cancer

Chen¹,

Ayscue²,

Bayasi³

et al. 2018

MIS

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of life after minimally invasive surgery for rectal cancer. Mini-invasive Surg 2018;2:42. http://dx. AbstractTraditional open surgical technique for rectal cancer is associated with significant morbidity and impact on quality of life. Multiple structures are at risk during total mesorectal excision, which may have profound impact on sexual function, and urinary and fecal continence. In addition, having a temporary or permanent ostomy can have a significant effect on overall well-being. Patients have reported post-operative problems such as chronic wounds, poor body image, inhibited work and social function. Minimally invasive surgery (MIS) is an evolving component of colon and rectal cancer treatment that may have benefits over open surgery. The increasing role of laparoscopy for colon and rectal cancer has been associated with decreased morbidity, improved pain control, and reduced length of stay. However, laparoscopic surgery in rectal cancer remains technically difficult due to the inherent limitations of operating in the pelvis. Robotic surgery is a newer method for treating rectal cancer developed to overcome these limitations. Transanal endoscopic microsurgery and transanal MIS are techniques to achieve local excision, avoiding proctectomy in select patients, potentially improving functional outcomes. Transanal total mesorectal excision is an even newer technique to facilitate dissection of low rectal cancers. Controversy remains about equivalence in oncologic outcomes when these MIS approaches are used for rectal cancer. Even more unclear is the effect of MIS approaches on quality of life and how they compare to open surgery. This review discusses the most current evidence on the impact of various MIS techniques on quality of life after rectal cancer surgery. Keywords:Quality of life, rectal cancer, minimally invasive surgery, laparoscopic, robotic, transanal endoscopic microsurgery, transanal minimally invasive surgery, transanal total mesorectal excision DECLARATIONS Authors' contributionsConception and design of the work, acquisition, analysis, interpretation of data, drafting and revising the work: Chen JH, Bello BL Conception and design of the work, revising the work:

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Section: Robotic Surgery For Rectal Cancermentioning

confidence: 62%

Section: Robotic Surgery For Rectal Cancermentioning

confidence: 99%

Quality of life after minimally invasive surgery for rectal cancer

Chen¹,

Ayscue²,

Bayasi³

et al. 2018

MIS

View full text Add to dashboard Cite

show abstract

“…Lastly, the rate of late complications after ESD and TEM should be addressed. While transient anal pain and anal incontinence are somewhat benign and expected complications of TEM, 21,38 12.7% rate of rectal stricture in the ESD group might seem worrisome. However, in all those cases, the lesion resected occupied 90% or more of the rectal circumference.…”

Section: Discussionmentioning

confidence: 94%

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Kimura

Kawaguti

Nahas

et al. 2020

J of Gastro and Hepatol

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Background and Aim Endoscopic submucosal dissection and transanal endoscopic microsurgery are good options for the treatment of rectal adenomas and early rectal carcinomas, but whether long‐term outcomes of these procedures are comparable is not known. The aim of this study was to address this question. Methods A retrospective single‐center study evaluating 98 consecutive procedures between June 2008 and December 2017 was performed in a tertiary cancer center. Consecutive patients who had undergone either endoscopic submucosal resection or transanal endoscopic microsurgery for rectal adenomas and early rectal carcinomas were evaluated, and long‐term recurrence and complication rates were compared. Results Both groups were similar regarding sex, age, preoperative surgical risk, and en bloc resection rate (95.7% in the endoscopic and 100% in the surgical group, P = 0.81). Mean follow‐up period was 37.6 months. Lesions resected endoscopically were significantly larger (68.5 mm) than those resected by transanal resection (44.5 mm), P = 0.003. Curative resections occurred in 97.2% of endoscopic resections and 85.2% of the surgical ones (P = 0.04). Comparing resections that fulfilled histologic curative criteria, there were no recurrences in the endoscopic group (out of 69 cases) and two recurrences in the transanal group (8.3% of 24 cases), P = 0.06. Late complications occurred in 12.7% of endoscopic procedures and 25.9% of surgical procedures (P = 0.13). Conclusions In our experience, endoscopic submucosal resection seems to have advantages over transanal endoscopic microsurgery, with similar en bloc resection rate and lower rate of late complications and recurrences. Multicenter randomized controlled trials are needed to support our findings.

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“…Doornebosch et al [ 24 ] even concluded that TEM has no deteriorating effect on fecal continence in the short term (6 months). However, in a retrospective study of 132 patients who underwent TEM with a median follow-up of 96 months, 38 (28.8%) patients reported Wexner score of 3 or more, leading to their conclusion that fecal incontinence after TEM is relatively high, and it significantly impairs quality of life [ 25 ]. To our surprise, 3 (2.1%) patients reported a major LARS after TEM in our study, and their symptoms did not improve by 26, 39, 90 months respectively.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors

Shi

Hou

et al. 2022

BMC Surg

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Background Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET). Methods A retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included. Results A total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3–2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS. Conclusions TEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.

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Fecal incontinence after transanal endoscopic microsurgery

Abstract: Fecal incontinence after TEM is more common than thought previously, resulting in significantly impaired quality of life. Older age at the time of operation was an independent risk factor for developing significant fecal incontinence.

Cited by 16 publications

References 27 publications

Quality of life after minimally invasive surgery for rectal cancer

Quality of life after minimally invasive surgery for rectal cancer

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors

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