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Quality of life and functional outcomes after transanal total mesorectal excision for rectal cancer—results from the implementation period in Denmark

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The standard operation for mid- and low rectal cancer total mesorectal excision (TME) is routinely performed as minimally invasive surgery. TME is associated with temporary or permanent functional impairment of pelvic organs, causing reduced quality of life (QoL). Concerns have been raised that the newest minimally invasive approach, transanal TME (TaTME), may further reduce urogenital and anorectal functions.

Objective

To determine if functional outcomes affecting QoL are altered after TaTME. Primary end-point is the impact of TaTME on QoL and functional outcomes. Secondary end-point is assessing differences in QoL and functional outcomes after TME surgery from below (TaTME) or above (transabdominal TME).

Design, setting, and participants

Observational study consisting of prospectively registered self-reported questionnaire data collected at baseline and follow-ups after TaTME. All patients who underwent TaTME during the Danish national implementation phase were included. Central surveillance of the implementation included questionnaires concerning QoL and functional outcomes. Analyses of functional results from the Danish cohort of the ROLARR trial (Jayne et al. in JAMA 318:1569–1580, (2017) are reported separately for perspective, representing the transabdominal approach to TME, i.e., laparoscopic- or robotic-assisted TME (LaTME/RoTME). Applied questionnaires include EORTC QLQ-C30, SF-36, LARS, ICIQ-MLUTS, ICIQ-FLUTS, IPSS, IIEF, SVQ, and FSFI.

Results

A total of 115 TaTME procedures were registered August 2016 to April 2019. LaTME/RoTME patients (n = 92) were operated on January 2011 to September 2014. A temporary postoperative decrease of QoL (global health status and functional scales) was observed, yet long-term results were unaffected by surgery in both groups. In TaTME patients, the anorectal dysfunction increased significantly (p < 0.001) from preoperative baseline to 13.5 months follow-up, where 67.5% (n = 52) reported major LARS symptoms. Urinary function was not significantly impaired after TME regardless of technique. The paucity of responses concerning sexual function precludes conclusions.

Conclusions

Although an initial reduction in QoL after TME occurs, it normalizes within the first year postoperatively. In concurrence with international results, we found that significant anorectal dysfunction is common after TaTME. No data on anorectal function was available for LaTME/RoTME patients for comparison. We found no indications that transanal TME is inferior to transabdominal TME surgery concerning urogenital functions or health-related QoL.

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Acknowledgements

The authors wish to thank Dr. Jayne et al., authors of the ROLARR trial [1], for supplying raw data from the Danish cohort. Furthermore, we thank the Scientific Committee of the Danish Colorectal Cancer Group (DCCG.dk) for its collaboration.

Funding

Dr. Bjoern was partially supported by the Louis-Hansen Foundation (private foundation). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    M. X. Bjoern & O. Bulut

  2. Centre for Surgical Science, Zealand University Hospital Køge, Køge, Denmark

    M. X. Bjoern, F. B. Clausen & I. Gögenur

  3. Zealand University Hospital Køge, Køge, Denmark

    M. Seiersen

  4. Colorectal Cancer Centre South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark

    F. Bech-Knudsen

  5. Copenhagen University Hospital North Zealand, Hillerød, Denmark

    J. E. Jansen

  6. Danish Colorectal Cancer Group (DCCG.Dk), Copenhagen, Denmark

    I. Gögenur & M. F. Klein

  7. Copenhagen University Hospital Herlev, Herlev, Denmark

    M. F. Klein

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  1. M. X. Bjoern
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Contributions

MXB and MFK wrote the main manuscript text and MXB prepared all figures and tables. All authors critically reviewed the manuscript.

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Correspondence to M. X. Bjoern.

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Appendix

Appendix

Table 2 Questionnaire response ratesa
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Table 3 Quality of life—TaTME patients
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Table 4 Quality of life—LaTME/RoTME patients
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Table 5 Anorectal function—TaTME patients
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Table 6 Urinary function—TaTME patients
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Table 7 Urinary function—LaTME/RoTME patients
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Table 8 Sexual function—all male patients
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Table 9 Sexual function—female TaTME patients
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Table 10 Sexual function—female LaTME/RoTME patients
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Bjoern, M., Clausen, F., Seiersen, M. et al. Quality of life and functional outcomes after transanal total mesorectal excision for rectal cancer—results from the implementation period in Denmark. Int J Colorectal Dis 37, 1997–2011 (2022). https://doi.org/10.1007/s00384-022-04219-2

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