Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer

Doornebosch, Pascal G.; Tollenaar, Rob A.E.M.; Gosselink, M.; Stassen, Laurents P. S.; Dijkhuis, C.M.; Schouten, W. R.; Velde, Cornelis Jh van de; Graaf, Eelco J. R. de

doi:10.1111/j.1463-1318.2006.01186.x

Cited by 86 publications

(49 citation statements)

References 49 publications

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“…Doornebosch and colleagues 24 also compared TEM to total mesorectal excision. They demonstrated no significant difference between the 2 strategies of transanal excision in postoperative quality of life, as measured with the EORTC-QLQ C30 and EQ-VAS scales.…”

Section: Researchmentioning

confidence: 99%

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Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Planting

Phang²,

Raval³

et al. 2013

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Background: Anal dilation during tumour excision with transanal endoscopic microsurgery (TEM) has caused concerns regarding postoperative anal function. We sought to determine whether TEM affects anorectal function and quality of life. Results: Forty patients received TEM; 30 of them met all inclusion criteria and agreed to participate. The median age was 70 (42-93) years, and median follow-up time between the interview and the operation was 365 (55-712) days. Tumours excised included 19 adenomas, 8 carcinomas and 3 carcinoid tumours. The median distance from the tumour to the anal verge was 6.5 (2-13) cm. Median length of stay was 1 (0-12) day. For most aspects of quality of life, there were no detectable differences after surgery. The EORTC QLQ-C30 showed a significant improvement in diarrhea (27.8 v. 10, p = 0.002). The FIQL scores improved with surgery (3.59 v. 3.85, p = 0.020). There was no difference in pre-versus postoperative FISI scores (6.7 v. 6.3, p = 0.93). Methods Conclusion:Despite a large operating rectoscope, TEM improves quality of life related to fecal incontinence and does not have a negative impact on fecal continence.Contexte : La dilatation de l'anus au cours de l'excision d'une tumeur par microchirurgie endoscopique transanale (MET) soulève des préoccupations quant à la fonction anale postopératoire. Nous avons cherché à déterminer si la MET a un effet sur la fonction anorectale et la qualité de vie.

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Section: Researchmentioning

confidence: 99%

“…The postoperative EORTC scores in our series are slightly better than those reported by Doornebosch and colleagues. 24 A possible explanation is that all their patients had a T1 adenocarcinoma.…”

Section: Researchmentioning

confidence: 99%

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Planting

Phang²,

Raval³

et al. 2013

cjs

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“…There are very few data regarding the anorectal function and quality of life after abdominal rectal resection and TME for ERC. Only two retrospective studies [191,192] comparing quality of life after TEM and TME for ERC have been published. Doornebosch et al [191] compared 31 patients undergoing TEM for a T1 rectal cancer with a sex-and age-matched sample of 31 T+N0 rectal cancer patients (3 T1 and 8 T2) undergoing sphincter saving rectal resection with TME and a sex-and age matched community-based sample of healthy people.…”

Section: How Does Radical Surgery For Erc Affect Patient Anorectal Fumentioning

confidence: 99%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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“…Since its introduction into clinical practice (5), TEM has progressively become the standard for treatment of benign polyps and early neoplasms in TAE (6,7). Currently, the excision of rectal tumors by TEM is associated with fewer surgery-associated morbidities, an improved postoperative anorectal function and a shortened postoperative recovery when compared with open or laparoscopic rectal resections (8,9). Frail elderly patients, patients who are otherwise not suitable candidates for a major rectal resection, and patients who categorically refuse to undergo a radical rectal excision with permanent stoma creation for early-stage rectal cancer, are candidates for TAE (17).…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).…”

Section: Introductionmentioning

confidence: 99%

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

Noura

Ohue

Miyoshi

et al. 2016

Molecular and Clinical Oncology

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Abstract. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique. However, TEMhas not yet achieved widespread use. Recently, transanal minimally invasive surgery (TAMIS) using single-port surgery devices has been reported. In the present study, TAMIS using a GelPOINT ® Path was performed in six patients with lower rectal cancer. A complete full-thickness excision was performed in all cases. The patient characteristics, operative techniques and operative outcomes were evaluated. The mean age of the patients was 63.0 years (range: 48-76). The mean operating time and blood loss were 86 min (range: 55-110) and 5 ml (range 0-10), respectively. There were no instances of morbidity or mortality. Additional transabdominal rectal resection was not performed, and adjuvant chemoradiotherapy was performed in all cases. The mean Wexner score was 0.6 (range: 0-3; n=5) at 6 months, and 0 (range: 0; n=4) at 12 months. TAMIS using a GelPOINT ® Path was revealed to be easy and safe to perform. Although only a small number of cases were treated, the anal function following surgery was shown to be favorable, and the operation was demonstrated to be sufficiently feasible. Based on these results, TAMIS may, in time, assume a major role in the resection of large adenomas and early rectal cancers. IntroductionThe rectum is a challenging area for surgeons to operate on due to its limited access. Although advances in conventional surgery have broadened the choice of sphincter-preserving procedures, definitive colostomy is still necessary in 10-30% of patients (1). Furthermore, the postoperative morbidity and mortality rates remain high (2). Besides urinary dysfunction, the disturbance of bowel function proves a major problem in ~30% of patients (3,4).Benign neoplasia and early-stage rectal cancer located in the rectum have been traditionally managed with transanal excision (TAE) using a conventional instrument, such as a Parks retractor. This approach, however, has several limitations, as exposure and visibility within the rectal lumen curtail the surgeon's ability to perform a high-quality oncological excision. Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).Although the instruments and procedures that are used in resection with TEM have remained largel...

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Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer

Cited by 86 publications

References 49 publications

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

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