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International Journal of Colorectal Disease

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01-01-2020 | Rectal Cancer | Original Article

Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution

Authors: Franco G. Marinello, Anna Curell, Ingrid Tapiolas, Gianluca Pellino, Francesc Vallribera, Eloy Espin

Published in: International Journal of Colorectal Disease | Issue 1/2020

Abstract

Purpose

The introduction of transanal endoscopic or minimally invasive surgery has allowed organ preservation for rectal tumors with good oncological results. Data on functional and quality-of-life (QoL) outcomes are scarce and controversial. This systematic review sought to synthesize fecal continence, QoL, and manometric outcomes after transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS).

Methods

A systematic review of the literature including Medline, Embase, and the Cochrane Library databases was conducted searching for articles reporting on functional outcomes after TEM or TAMIS between January 1995 and June 2018. The evaluated outcome parameters were pre- and postoperative fecal continence (primary endpoint), QoL, and manometric results. Data were extracted using the same scales and measurement units as from the original study.

Results

A total of 29 studies comprising 1297 patients were included. Fecal continence outcomes were evaluated in 23 (79%) studies with a wide variety of assessment tools and divergent results. Ten studies (34%) analyzed QoL changes, and manometric variables were assessed in 15 studies (51%). Most studies reported some deterioration in manometric scores without major QoL impairment. Due to the heterogeneity of the data, it was not possible to perform any pooled analysis or meta-analysis.

Conclusions

These techniques do not seem to affect continence by themselves except in minor cases. The possibility of worsened function after TEM and TAMIS should not be underestimated. There is a need to homogenize or standardize functional and manometric outcomes assessment after TEM or TAMIS.

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Title: Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution
Authors: Franco G. Marinello
Anna Curell
Ingrid Tapiolas
Gianluca Pellino
Francesc Vallribera
Eloy Espin
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Minimally Invasive Surgery
Published in: International Journal of Colorectal Disease / Issue 1/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03439-3

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Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution

Abstract

Purpose

Methods

Results

Conclusions

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