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

Abstract

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.

Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer

“…Previous studies have demonstrated that morbidity rates after CRT and local excision are not insignificant. For these reasons, it seems inappropriate to compare the present study with previous studies that included patients with benign disease or early‐stage (pT1–2) rectal cancer.…”

“…Although several studies have investigated the impact of local excision for rectal neoplasms on bowel and sexual function and on QoL, most of these studies had small sample sizes, were retrospective, comprised single‐institution experiences, included patients with benign lesions, and did not use validated questionnaires to assess functional results and QoL.…”

Transanal Minimally Invasive Surgery

“…3,4 however, no clinically significant postoperative fecal incontinence has been reported. 5,6 transanal minimally invasive surgery (tamis) is a relatively new technique using a disposable flexible port in combination with conventional laparoscopic instruments for local excision of rectal polyps. 7,8 the startup costs for this method are less compared with that of the tem equipment, although there are ongoing costs per case for flexible ports.…”

Preclinical cadaveric study of transanal robotic proctectomy with total mesorectal excision combined with laparoscopic assistance

“…No anastomosis was performed in this study, as the major end‐point of the study was to assess the feasibility of robotic transanal proctectomy. Although evaluation of postoperative anal continence is not possible in this model, as the size of the proctoscope in contact with the patient is the same as that in the TEM platform, no incontinence is expected .…”