Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome

Abstract

BackgroundTransanal total mesorectal excision (TaTME) has rapidly become an important component of the treatment of rectal cancer surgery. Cohort studies have shown feasibility concerning procedure, specimen quality and morbidity. However, concerns exist about quality of life and ano(neo)rectal function. The aim of this study was to prospectively evaluate quality of life in patients following TaTME for rectal cancer with anastomosis.MethodsConsecutive patients who underwent restorative TaTME surgery for rectal adenocarcinoma in an academic teaching center with tertiary referral function were evaluated. Validated questionnaires were prospectively collected. Quality of life was assessed by the EuroQol 5D (EQ-5D), European Organization for Research and Treatment of Cancer’s QLQ-C30 and QLQ-CR29 and low anterior resection syndrome (LARS) scale. Outcomes of the questionnaires at 1 and 6 months were compared with preoperative (baseline) values.ResultsThirty patients after restorative TaTME for rectal cancer were included. Deterioration for all domains was mainly observed at 1 month after surgery compared to baseline, but most outcomes had returned to baseline at 6 months. Social function and anal pain remained significantly worse at 6 months. Major LARS (score >30) was 33% at 6 months after ileostomy closure. No end colostomies were required.ConclusionsTaTME is associated with acceptable quality of life and functional outcome at 6 months after surgery comparable to published results after conventional laparoscopic low anterior resection.

Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision

“…A study by Pontallier et al [19] reported severe symptoms after both transanal and laparoscopic approaches for low rectal cancer, with major LARS in 82 and 76% of the transanal and standard laparoscopy patients, respectively. A recently published study by Koedam et al reported 33% major LARS in patients after TaTME [20]. While both studies showed significant LARS symptoms after transanal resection, their results cannot be compared because the two studies included different patient groups, with more distal tumors and intersphincteric resections in the Pontallier study [19].…”

The role of transanal total mesorectal excision in rectal surgery

“…Koedam et al [14] assessed the patient-reported quality of life of 30 consecutive patients who underwent TaTME for rectal cancer. Quality of life was assessed by three questionnaires: Overall Quality of Life (EQ-5D-3L), Colorectal Cancer Specific Quality of Life (EORTC: QLQ-C30 and QLQ-CR29) and Anterior Resection Syndrome (LARS) scale.…”

Új távlatok a végbélrák sebészetében: Transanalis teljes mesorectum excisio. Kezdeti eredményeink

“…Előnyként említhe-tő az alacsonyabb végleges colostomaképzési arány [33], a jobb funkcionális mutatók (inkontinencia, vizelési és szexuális funkciók tekintetében) [34], valamint a posztoperatív morbiditási eredmények némi javulása [32,33]. Mivel ezek az eredmények nem randomizált prospektív vizsgálatok különböző sebésztechnikát alkalmazó karjainak összehasonlításából származnak, így magas szintű evidencia helyett csupán jelzésértékű klinikai leletek.…”

“…Műtéti jellemzők, szövődmények, posztoperatív jellemzők [34]. Az életminőségi és funkcionális eredmények kritikus értékelése a TaTME-műtét klinikai helyének hosszú távú megítéléséhez alapvető fontosságú szempontként merül fel.…”