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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2016

01-02-2016

Quality of life in non-early rectal cancer treated by neoadjuvant radio-chemotherapy and endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) versus laparoscopic total mesorectal excision

Authors: Giancarlo D’Ambrosio, Alessandro M. Paganini, Andrea Balla, Silvia Quaresima, Pietro Ursi, Paolo Bruzzone, Andrea Picchetto, Fabrizio I. Mattei, Emanuele Lezoche

Published in: Surgical Endoscopy | Issue 2/2016

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Abstract

Background

In selected patients with N0 rectal cancer, endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Aim of this study is to evaluate the short- and medium-term quality of life (QoL) from a retrospective analysis of prospectively collected data in patients with iT2–iT3 N0-N+ rectal cancer, who underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT).

Methods

Thirty patients with iT2–iT3 rectal cancer who underwent ELRR by TEM (n = 15) or LTME (n = 15) were enrolled in this study. The choice for one operation or the other was made on the basis of predefined criteria. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission, after n-RCT and 1, 6, and 12 months after surgery.

Results

No statistically significant differences in QoL evaluation were observed between the two groups, both at admission and after n-RCT. At 1 month after surgery, significantly better results in the ELRR group were observed by QLQ-C30 in: Nausea/Vomiting (p = 0.05), Appetite Loss (p = 0.003), Constipation (p = 0.05), and by QLQ-CR38 in: Body Image (p = 0.05), Sexual Functioning (p = 0.03), Future Perspective (p = 0.05) and Weight Loss (p = 0.036). At 6 months after surgery, a statistically significant worse impact after LTME was observed by QLQ-C30 in: Global Health Status (p = 0.05), Emotional Functioning (p = 0.021), Dyspnea (p = 0.008), Insomnia (p = 0.012), Appetite Loss (p = 0.014) and by QLQ-CR38 in Body Image (p = 0.05) and Defecation Problems (p = 0.001). At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the QLQ-CR38 still showed better results of ELRR versus LTME in Body Image (p = 0.006), Defecation Problems (p = 0.01), and Weight Loss (p = 0.005).

Conclusions

Based on the present series, in selected patients, earlier restoration of patients’ functions is observed after ELRR by TEM than after LTME.
Literature
1.
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482CrossRefPubMed
2.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899CrossRefPubMed
3.
Dahlberg M, Glimelius B, Påhlman L (1999) Improved survival and reduction in local failure rates after preoperative radiotherapy: evidence for the generalizability of the results of Swedish Rectal Cancer Trial. Ann Surg 229(4):493–497PubMedCentralCrossRefPubMed
4.
Hospers GA, Punt CJ, Tesselaar ME, Cats A, Havenga K, Leer JW, Marijnen CA, Jansen EP, Van Krieken HH, Wiggers T, Van de Velde CJ, Mulder NH (2007) Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I–II multicenter study of the Dutch Colorectal Cancer Group. Ann Surg Oncol 14(10):2773–2779PubMedCentralCrossRefPubMed
5.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed
6.
Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50(4):464–471CrossRefPubMed
7.
Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132CrossRefPubMed
8.
Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556CrossRefPubMed
9.
Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502PubMed
10.
Kuzu MA, Topçu O, Uçar K, Ulukent S, Unal E, Erverdi N, Elhan A, Demirci S (2002) Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients. Dis Colon Rectum 45:1359–1366CrossRefPubMed
11.
Williamson MER, Lewis WG, Finan PJ, Miller AS, Holdsworth PJ, Johnston D (1995) Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum 38:411–418CrossRefPubMed
12.
Rasmussen OO, Petersen IK, Christiansen J (2003) Anorectal function following low anterior resection. Colorectal Dis 5:258–261CrossRefPubMed
13.
Camilleri-Brennan J, Steele RJ (2002) Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis 4:61–66CrossRefPubMed
14.
Grumann MM, Noack EM, Hoffmann IA, Schlag PM (2001) Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 233:149–156PubMedCentralCrossRefPubMed
15.
Chang PL, Fan AH (1983) Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol 130:948–951PubMed
16.
Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum-testing a new method in animal experiments. Leber Magen Darm 13(2):73–77PubMed
17.
Lezoche E, Guerrieri M, Paganini AM, Feliciotti F (1998) Transanal endoscopic microsurgical excision of irradiated and non irradiated rectal cancer. A 5-year experience. Surg Laparosc Endosc 8(4):249–256CrossRefPubMed
18.
Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G (2005) Long-term results in patients with T2–3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 92(12):1546–1552CrossRefPubMed
19.
Lezoche E, Baldarelli M, Lezoche G, Paganini AM, Gesuita R, Guerrieri M (2012) Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg 99(9):1211–1218. doi:10.​1002/​bjs.​8821 CrossRefPubMed
20.
Lezoche E, Paganini AM, Fabiani B, Balla A, Vestri A, Pescatori L, Scoglio D, D’Ambrosio G, Lezoche G (2014) Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision. Surg Endosc 28(1):227–234. doi:10.​1007/​s00464-013-3166-2 CrossRefPubMed
21.
Sobin Lh, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. Wiley, Hoboken
22.
Paganini AM, Balla A, Quaresima S, D’Ambrosio G, Bruzzone P, Lezoche E (2014) Tricks to decrease the suture line dehiscence rate during endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM). Surg Endosc 29(5):1045–1050. doi:10.​1007/​s00464-014-3776-3 CrossRefPubMed
23.
Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, D’Ambrosio G, Lezoche E (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17(10):1530–1535CrossRefPubMed
24.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) 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 85(5):365–376CrossRefPubMed
25.
Sprangers MA, te Velde A, Aaronson NK (1999) The construction and testing of the eortc colorectal cancer-specific quality of life questionnaire module (qlq-cr38). European Organization for research and treatment of cancer study group on quality of life. Eur J Cancer 35(2):238–247CrossRefPubMed
26.
27.
Kinn AC, Ohman U (1986) Bladder and sexual function after surgery for rectal cancer. Dis Colon Rectum 29(1):43–48CrossRefPubMed
28.
Santangelo ML, Romano G, Sassaroli C (1987) Sexual function after resection for rectal cancer. Am J Surg 154(5):502–504CrossRefPubMed
29.
Fazio VW, Fletcher J, Montague D (1980) Prospective study of the effect of resection of the rectum on male sexual function. World J Surg 4(2):149–152CrossRefPubMed
30.
Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238(2):203–213PubMedCentralPubMed
31.
32.
Griffen FD, Knight CD Sr, Whitaker JM, Knight CD Jr (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211(6):745–751 discussion 751-2 PubMedCentralCrossRefPubMed
33.
Stockholm Rectal Cancer Study Group (1987) Short-term preoperative radiotherapy for adenocarcinoma of the rectum. An interim analysis of a randomized multicenter trial. Am J Clin Oncol 10(5):369–375CrossRef
34.
Stockholm Rectal Cancer Study Group (1990) Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Cancer. 66(1):49–55CrossRef
35.
Cedermark B, Johansson H, Rutqvist LE, Wilking N (1995) The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Colorectal Cancer Study Group. Cancer 75(9):2269–2275CrossRefPubMed
36.
Doornebosch PG, Tollenaar RA, Gosselink MP, Stassen LP, Dijkhuis CM, Schouten WR, van de Velde CJ, de Graaf EJ (2007) Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis 9:553–558CrossRefPubMed
37.
Enker WE, Havenga K, Polyak T, Thaler H, Cranor M (1997) Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 21:715–720CrossRefPubMed
38.
Juul T, Ahlberg M, Biondo S, Espin E, Jimenez LM, Matzel KE, Palmer GJ, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum 57(5):585–591. doi:10.​1097/​DCR.​0000000000000116​ CrossRefPubMed
39.
40.
Montesani C, Pronio A, Santella S, Boschetto A, Aguzzi D, Pirozzi R, D’Amato A, Vestri A (2004) Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis. Clinical and instrumental study. Hepatogastroenterology 51(57):718–721PubMed
41.
White CA, Hunt JC (1997) Psychological factors in postoperative adjustment to stoma surgery. Ann R Coll Surg Engl 79(1):3–7PubMedCentralPubMed
42.
Staudacher C, Di Palo S, Tamburini A, Vignali A, Orsenigo E (2007) Total mesorectal excision (TME) with laparoscopic approach: 226 consecutive cases. Surg Oncol 16(Suppl 1):S113–S116CrossRefPubMed
43.
Rosati R, Bona S, Romario UF, Elmore U, Furlan N (2007) Laparoscopic total mesorectal excision after neoadjuvant chemoradiotherapy. Surg Oncol 16(Suppl 1):S83–S89CrossRefPubMed
44.
Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 16(6):370–376CrossRefPubMed
45.
46.
Cataldo PA, O’Brien S, Osler T (2005) Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 48(7):1366–1371CrossRefPubMed
47.
Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643. doi:10.​1002/​bjs.​7584 CrossRefPubMed
48.
Planting A, Phang PT, Raval MJ, Brown CJ (2013) Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life. Can J Surg 56(4):243–248PubMedCentralCrossRefPubMed
49.
50.
Dahlberg M, Glimelius B, Graf W, Påhlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41(5):543–549 discussion 549–51 CrossRefPubMed
51.
52.
Coco C, Rizzo G, Mattana C, Gambacorta MA, Verbo A, Barbaro B, Vecchio FM, Pafundi DP, Mastromarino MG, Valentini V (2013) Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome. Surg Endosc 27(8):2860–2867. doi:10.​1007/​s00464-013-2842-6 CrossRefPubMed
53.
Metadata
Title
Quality of life in non-early rectal cancer treated by neoadjuvant radio-chemotherapy and endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) versus laparoscopic total mesorectal excision
Authors
Giancarlo D’Ambrosio
Alessandro M. Paganini
Andrea Balla
Silvia Quaresima
Pietro Ursi
Paolo Bruzzone
Andrea Picchetto
Fabrizio I. Mattei
Emanuele Lezoche
Publication date
01-02-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4232-8

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