Surgical Endoscopy

, Volume 28, Issue 1, pp 193–202 | Cite as

Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions

  • Elsa B. Valsdottir
  • Shadi S. Yarandi
  • John H. Marks
  • Gerald J. Marks



Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter’s musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years.


A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment.


Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence.


Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.


Fecal incontinence Quality of life Questionnaire Transanal endoscopic microsurgery 



Elsa B.Valsdottir, Shadi S. Yarandi, John H. Marks, and Gerald J. Marks have no conflicts of interest or financial ties to disclose.


  1. 1.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMedCrossRefGoogle Scholar
  2. 2.
    Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMedGoogle Scholar
  3. 3.
    Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242:212–223PubMedCrossRefGoogle Scholar
  4. 4.
    Rasmussen OO, Petersen IK, Christiansen J (2003) Anorectal function following low anterior resection. Colorectal Dis 5:258–261PubMedCrossRefGoogle Scholar
  5. 5.
    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 51:718–721PubMedGoogle Scholar
  6. 6.
    White CA, Hunt JC (1997) Psychological factors in postoperative adjustment to stoma surgery. Ann R Coll Surg Engl 79:3–7PubMedCentralPubMedGoogle Scholar
  7. 7.
    Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, Baldwin CM, McMullen CK, Rawl SM, Matayoshi E, Coons SJ, Hornbrook MC (2009) Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 27:4664–4670PubMedCrossRefGoogle Scholar
  8. 8.
    Orsini RG, Thong MS, van de Poll-Franse LV, Slooter GD, Nieuwenhuijzen GA, Rutten HJ, de Hingh IH (2013) Quality of life of older rectal cancer patients is not impaired by a permanent stoma. Eur J Surg Oncol 39:164–170PubMedCrossRefGoogle Scholar
  9. 9.
    Buess GF, Raestrup H (2001) Transanal endoscopic microsurgery. Surg Oncol Clin N Am 10:709–731, xiGoogle Scholar
  10. 10.
    Marks G, Mohiuddin MM, Masoni L, Pecchioli L (1990) High-dose preoperative radiation and full-thickness local excision: a new option for patients with select cancers of the rectum. Dis Colon Rectum 33:735–739PubMedCrossRefGoogle Scholar
  11. 11.
    Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071; discussion 1071–1064Google Scholar
  12. 12.
    Stipa F, Burza A, Lucandri G, Ferri M, Pigazzi A, Ziparo V, Casula G, Stipa S (2006) Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5-year follow-up study. Surg Endosc 20:541–545PubMedCrossRefGoogle Scholar
  13. 13.
    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 9:553–558PubMedCrossRefGoogle Scholar
  14. 14.
    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 16:370–376PubMedCrossRefGoogle Scholar
  15. 15.
    Doornebosch PG, Gosselink MP, Neijenhuis PA, Schouten WR, Tollenaar RA, de Graaf EJ (2008) Impact of transanal endoscopic microsurgery on functional outcome and quality of life. Int J Colorectal Dis 23:709–713PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Cataldo PA, O’Brien S, Osler T (2005) Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 48:1366–1371PubMedCrossRefGoogle Scholar
  17. 17.
    Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2001) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643Google Scholar
  18. 18.
    Rockwood TH (2004) Incontinence severity and QOL scales for fecal incontinence. Gastroenterology 126:S106–S113PubMedCrossRefGoogle Scholar
  19. 19.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (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 85:365–376PubMedCrossRefGoogle Scholar
  20. 20.
    Marks JH, Valsdottir EB, DeNittis A, Yarandi SS, Newman DA, Nweze I, Mohiuddin M, Marks GJ (2009) Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc 23:1081–1087PubMedCrossRefGoogle Scholar
  21. 21.
    Duek SD, Issa N, Hershko DD, Krausz MM (2008) Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum 51:379–384; discussion 384Google Scholar
  22. 22.
    Kreissler-Haag D, Schuld J, Lindemann W, Konig J, Hildebrandt U, Schilling M (2008) Complications after transanal endoscopic microsurgical resection correlate with location of rectal neoplasms. Surg Endosc 22:612–616PubMedCrossRefGoogle Scholar
  23. 23.
    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 92:1546–1552PubMedCrossRefGoogle Scholar
  24. 24.
    Whitehouse PA, Tilney HS, Armitage JN, Simson JN (2006) Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas. Colorectal Dis 8:795–799PubMedCrossRefGoogle Scholar
  25. 25.
    Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284PubMedCrossRefGoogle Scholar
  26. 26.
    Dias AR, Nahas CS, Marques CF, Nahas SC, Cecconello I (2009) Transanal endoscopic microsurgery: indications, results, and controversies. Tech Coloproctol 13:105–111PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Elsa B. Valsdottir
    • 1
    • 3
  • Shadi S. Yarandi
    • 1
    • 2
  • John H. Marks
    • 1
  • Gerald J. Marks
    • 1
  1. 1.Department of Colorectal SurgeryLankenau Hospital and Institute of Medical ResearchWynnewoodUSA
  2. 2.School of MedicineEmory UniversityAtlantaUSA
  3. 3.Department of SurgeryUniversity Hospital of IcelandReykjavikIceland

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