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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

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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.

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Disclosures

Giancarlo D’Ambrosio, Alessandro M. Paganini, Andrea Balla, Silvia Quaresima, Pietro Ursi, Paolo Bruzzone, Andrea Picchetto, Fabrizio I. Mattei, and Emanuele Lezoche have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy

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

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  1. Giancarlo D’Ambrosio
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  2. Alessandro M. Paganini
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Correspondence to Giancarlo D’Ambrosio or Andrea Balla.

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D’Ambrosio, G., Paganini, A.M., Balla, A. et al. 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. Surg Endosc 30, 504–511 (2016). https://doi.org/10.1007/s00464-015-4232-8

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