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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 8/2019

01-08-2019 | Rectal Cancer | Original Article

Quality of Life After Surgery for Rectal Cancer: a Comparison of Functional Outcomes After Transanal and Laparoscopic Approaches

Authors: Maya Xania Bjoern, Sarah Nielsen, Sharaf Karim Perdawood

Published in: Journal of Gastrointestinal Surgery | Issue 8/2019

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Abstract

Background

The aim in rectal cancer surgery is to cure with minimal impact on the quality of life. Transanal total mesorectal excision (TaTME) seems to be a safe and feasible alternative to laparoscopic TME (LaTME). However, limited data are available on the functional outcomes after TaTME. We aimed to study the quality of life (QoL), through questionnaires, comparing different functional outcomes after TaTME and LaTME.

Methods

Consecutive patients who underwent TME between 2010 and 2017 at Slagelse Hospital, Denmark, were included based on certain criteria. Patients were divided according to the surgical technique (TaTME vs LaTME). The study was based on telephone interviews using the questionnaires: EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome (LARS) score, and International Prostate Symptom Score (IPSS) for male patients. Patients in this study had a follow-up time of at least 8 months.

Results

Overall, global health status was similar between the groups (p = 0.625). Anorectal symptoms were significantly in disfavor of TaTME including buttock pain (p = 0.011), diarrhea (p = 0.009), clustering of stools (p = 0.017), and urgency (p = 0.032), yet total LARS score was comparable (p = 0.054). We found comparable sexual results and an overall higher satisfaction with urinary status in TaTME group (p = 0.010), yet no difference in IPSS symptoms (p = 0.236).

Conclusions

Anorectal dysfunction may occur after total mesorectal excision (TME) regardless of surgical technique, frequently more in after TaTME. The LARS symptoms and the overall quality of life status were however comparable. TaTME had a positive impact on the reported QoL, related to urinary symptoms.
Literature
1.
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, m.fl. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg. July 2017;266(1):111–7.CrossRefPubMed
2.
Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, m.fl. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg. August 2015;221(2):415–23.CrossRefPubMed
3.
Perdawood SK, Al Khefagie GAA. Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis Off J Assoc Coloproctology G B Irel. January 2016;18(1):51–8.
4.
Xu W, Xu Z, Cheng H, Ying J, Cheng F, Xu W, m.fl. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. December 2016;42(12):1841–50.
5.
Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis Off J Assoc Coloproctology G B Irel. January 2016;18(1):19–36.
6.
Bjorn MX, Perdawood SK. Transanal total mesorectal excision--a systematic review. Dan Med J. July 2015;62(7).
7.
Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, m.fl. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet Lond Engl. 7. March 2009;373(9666):821–8.CrossRef
8.
Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol Off J Am Soc Clin Oncol. 10. January 2008;26(2):303–12.CrossRef
9.
Perdawood SK, Thinggaard BS, Bjoern MX. Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc. May 2018;32(5):2312–21.CrossRefPubMed
10.
Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M. Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg. November 2011;98(11):1635–43.CrossRefPubMed
11.
Bruheim K, Guren MG, Skovlund E, Hjermstad MJ, Dahl O, Frykholm G, m.fl. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 15. March 2010;76(4):1005–11.CrossRefPubMed
12.
Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Furst A, m.fl. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg. September 2007;246(3):481–8-490.CrossRefPubMedPubMedCentral
13.
Rasmussen OO, Petersen IK, Christiansen J. Anorectal function following low anterior resection. Colorectal Dis Off J Assoc Coloproctology G B Irel. May 2003;5(3):258–61.
14.
15.
Fayers PM AN, Bjordal K, et al. The EORTC QLQ-C30 Scoring Manual (3rd Edition). Eur Organ Res Treat Cancer. 2001;
16.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, m.fl. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 3. March 1993;85(5):365–76.CrossRefPubMed
17.
Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, m.fl. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer Oxf Engl 1990. November 2009;45(17):3017–26.
18.
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, m.fl. Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry. Ann Surg. 5. January 2018;
19.
Chen TY-T, Wiltink LM, Nout RA, Meershoek-Klein Kranenbarg E, Laurberg S, Marijnen CAM, m.fl. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer. June 2015;14(2):106–14.CrossRefPubMed
20.
Jimenez-Gomez LM, Espin-Basany E, Marti-Gallostra M, Sanchez-Garcia JL, Vallribera-Valls F, Armengol-Carrasco M. Low anterior resection syndrome: a survey of the members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP). Int J Colorectal Dis. April 2016;31(4):813–23.CrossRefPubMed
21.
Emmertsen KJ, Laurberg S. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. September 2013;100(10):1377–87.CrossRefPubMed
22.
Biviano I, Balla A, Badiali D, Quaresima S, D’Ambrosio G, Lezoche E, m.fl. Anal function after endoluminal locoregional resection by transanal endoscopic microsurgery and radiotherapy for rectal cancer. Colorectal Dis Off J Assoc Coloproctology G B Irel. June 2017;19(6):O177–85.
23.
Kneist W, Wachter N, Paschold M, Kauff DW, Rink AD, Lang H. Midterm functional results of taTME with neuromapping for low rectal cancer. Tech Coloproctology. January 2016;20(1):41–9.CrossRef
24.
Koedam TWA, van Ramshorst GH, Deijen CL, Elfrink AKE, Meijerink WJHJ, Bonjer HJ, m.fl. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctology. January 2017;21(1):25–33.CrossRef
25.
Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, m.fl. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc. 2. July 2018;
26.
Andersson J, Angenete E, Gellerstedt M, Angeras U, Jess P, Rosenberg J, m.fl. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg. June 2013;100(7):941–9.CrossRefPubMedPubMedCentral
27.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. May 2012;255(5):922–8.CrossRefPubMed
28.
Juul T, Battersby NJ, Christensen P, Janjua AZ, Branagan G, Laurberg S, m.fl. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis Off J Assoc Coloproctology G B Irel. October 2015;17(10):908–16.
29.
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, m.fl. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg. 4. October 2016;
30.
Battersby NJ, Juul T, Christensen P, Janjua AZ, Branagan G, Emmertsen KJ, m.fl. Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study. Dis Colon Rectum. April 2016;59(4):270–80.CrossRefPubMed
31.
Pontallier A, Denost Q, Van Geluwe B, Adam J-P, Celerier B, Rullier E. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc. November 2016;30(11):4924–33.CrossRefPubMed
32.
Cox D, Fitzpatrick R, Fletcher A, Jones D. Quality-of-life assessment: can we keep it simple? J R Stat Soc. 1992;155:353–93.CrossRef
Metadata
Title
Quality of Life After Surgery for Rectal Cancer: a Comparison of Functional Outcomes After Transanal and Laparoscopic Approaches
Authors
Maya Xania Bjoern
Sarah Nielsen
Sharaf Karim Perdawood
Publication date
01-08-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 8/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4057-6

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