Journal of Gastrointestinal Surgery

, Volume 22, Issue 6, pp 1089–1097 | Cite as

Comparative Quality of Life in Patients Following Transanal Minimally Invasive Surgery and Healthy Control Subjects

  • Stefan H. E. M. Clermonts
  • Yu-Ting van Loon
  • Dareczka K. Wasowicz
  • Barbara S. Langenhoff
  • David D. E. Zimmerman
Original Article



Transanal minimally invasive surgery (TAMIS) is considered the successor of transanal endoscopic microsurgery (TEMS). It makes use of more readily available laparoscopic instruments and single-port access platforms with similar perioperative, clinical and oncological outcomes. Little is known about quality of life (QoL) outcomes after the use of TAMIS. The aim of this study was to assess QoL after TAMIS in our patients and compare this with QoL in the healthy Dutch population.


All patients undergoing TAMIS for selected rectal neoplasms between October 2011 and March 2014 were included in this analysis. Patients were studied for a minimal period of 24 months. QoL outcomes were measured using the Short-Form 36 Health Survey (SF-36) questionnaire; faecal continence was measured using the Faecal Incontinence Severity Index questionnaire. Patient reported outcomes were compared to case-matched healthy Dutch control subjects. We hypothesise that undergoing TAMIS will subsequently result in a decreased quality of life in patients compared to healthy individuals.


Thirty-seven patients (m:f = 17:20, median 67 years) were included in the current analysis. In four patients (10.8%), postoperative complications occurred. The median follow-up was 36 (range 21–47) months. Postoperative QoL scores are similar comparable to those reported by Dutch healthy controls. Patients reported a statistically significant better QoL score in the ‘bodily pain’ domain when compared to the controls (81.8 vs. 74.1 points) (p = 0.01). Significant worse QoL scores for the ‘social functioning’ domain were reported by patients after TAMIS (84.4 vs. 100 points) (p = 0.03).


TAMIS seems to be a safe technique with postoperative QoL scores similar to that of healthy case matched controls in 3-year follow-up. There seems to be no association between faecal incontinence and reported QoL. Negative effects of TAMIS on social functioning of patients should not be underestimated and should be discussed during preoperative counselling.


Transanal minimally invasive surgery TAMIS TEM Quality of life QoL Functional outcome SF-36 



We thank J. Kieffer, Ph.D, and N.K. Aaronson, Ph.D, of the Division of Psychosocial Research and Epidemiology at The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital (NKI-AVL), for providing the reference values of the healthy Dutch population.

Author’s Contributions

S.H.E.M. Clermonts, Y.T. van Loon, D.K. Wasowicz, B.S. Langenhoff and D.D.E. Zimmerman participated and contributed equally to the content of the following manuscript.

Source of Funding

The research for this manuscript was not financially supported and none of the authors had any relevant financial relationships.


  1. 1.
    Buess, G., et al., A system for a transanal endoscopic rectum operation. Chirurg, 1984. 55(10): p. 677–80.PubMedGoogle Scholar
  2. 2.
    Moore, J.S., et al., Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum, 2008. 51(7): p. 1026–30; discussion 1030-1.CrossRefPubMedGoogle Scholar
  3. 3.
    de Graaf, E.J., et al., Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis, 2011. 13(7): p. 762–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Atallah, S., M. Albert, and S. Larach, Transanal minimally invasive surgery: a giant leap forward. Surg Endosc, 2010. 24(9): p. 2200–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Barendse, R.M., et al., Transanal employment of single access ports is feasible for rectal surgery. Ann Surg, 2012. 256(6): p. 1030–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Dafnis, G., et al., Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis, 2004. 6(5): p. 336–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Herman, R.M., et al., Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis, 2001. 16(6): p. 370–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Doornebosch, P.G., et al., Impact of transanal endoscopic microsurgery on functional outcome and quality of life. Int J Colorectal Dis, 2008. 23(7): p. 709–13.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Planting, A., et al., Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life. Can J Surg, 2013. 56(4): p. 243–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Allaix, M.E., et al., Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg, 2011. 98(11): p. 1635–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Clermonts S.H.E.M., et al., Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate term functional results. Int J Colorectal Dis, 2017. 32(12):1677–1685.CrossRefPubMedGoogle Scholar
  12. 12.
    Schiphorst, A.H., et al., Transanal minimally invasive surgery: initial experience and short-term functional results. Dis Colon Rectum, 2014. 57(8): p. 927–32.CrossRefPubMedGoogle Scholar
  13. 13.
    Rockwood, T.H., et al., Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum, 1999. 42(12): p. 1525–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Rockwood, T.H., et al., Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum, 2000. 43(1): p. 9–16; discussion 16-7.CrossRefPubMedGoogle Scholar
  15. 15.
    Aaronson, N.K., et al., Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol, 1998. 51(11): p. 1055–68.CrossRefPubMedGoogle Scholar
  16. 16.
    Ware, J.E., Jr. and C.D. Sherbourne, The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 1992. 30(6): p. 473–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Likert, R., A technique for the measurement of attitudes, in Archives of psychology 1932. p. 1–55.Google Scholar
  18. 18.
    Ware JE, Kosinski M., Keller SD., SF-36 physical and menta; summery scales: a user's manual. 4th printing, revised ed. Boston, MA: Health Institue. 1994.Google Scholar
  19. 19.
    Albert, M.R., et al., Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum, 2013. 56(3): p. 301–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Verseveld, M., et al., Transanal minimally invasive surgery: impact on quality of life and functional outcome. Surg Endosc, 2016. 30(3):1184–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Holzer, B., et al., Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy? Dis Colon Rectum, 2005. 48(12): p. 2209–16.CrossRefPubMedGoogle Scholar
  22. 22.
    Restivo, A., et al., Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis, 2016. 31(2): p. 257–66.CrossRefPubMedGoogle Scholar
  23. 23.
    Nord, E., The significance of contextual factors in valuing health states. Health Policy, 1989. 13(3): p. 189–98.CrossRefPubMedGoogle Scholar
  24. 24.
    Anthony, T., et al., The effect of treatment for colorectal cancer on long-term health-related quality of life. Ann Surg Oncol, 2001. 8(1): p. 44–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Bordeianou, L., et al., Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis, 2008. 10(3): p. 273–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Langenhoff, B.S., et al., Quality of life after surgical treatment of colorectal liver metastases. Br J Surg, 2006. 93(8): p. 1007–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Bernhard, J., et al., Quality of life as subjective experience: reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Swiss Group for Clinical Cancer Research (SAKK). Ann Oncol, 1999. 10(7): p. 775–82.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Stefan H. E. M. Clermonts
    • 1
  • Yu-Ting van Loon
    • 1
  • Dareczka K. Wasowicz
    • 1
  • Barbara S. Langenhoff
    • 1
  • David D. E. Zimmerman
    • 1
  1. 1.Department of SurgeryETZ (Elisabeth-TweeSteden Hospital)TilburgThe Netherlands

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