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Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy

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Abstract

Background

In patients who exhibit a complete clinical response after radio-chemotherapy for rectal cancer, the standard surgical approach might constitute overtreatment. The aim of this study is to analyse the outcomes of anorectal function and quality of life after transanal endoscopic microsurgery (TEM) in irradiated patients with complete clinical response.

Patients and methods

Between 2007 and 2014, 84 patients who were diagnosed with stage T2–T3–T4 N0 rectal cancer before chemoradiotherapy showed a complete clinical response to neoadjuvant therapy and underwent TEM. All patients were evaluated before and 1 year after TEM using the Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) questionnaire to determine the impact of this surgical technique on the degree of faecal continence. To assess the quality of life of patients after surgery, we administered the Fecal Incontinence Quality of Life Scale.

Results

Twenty-three patients exhibited a worse incontinence status after surgical intervention (27.4; 95% CI 18.2–38.2). These patients experienced a median positive absolute variation in the CCF-FIS of four points (95% CI 3.5–4.5; p < 0.001). Female sex and age showed a significant correlation with the worsening of continence status. Scores on the Fecal Incontinence Quality of Life Index Scale did not show a significant difference before and after TEM.

Conclusions

TEM may be an alternative treatment for patients with rectal cancer who exhibit a complete clinical response to neoadjuvant chemoradiotherapy because it offers the possibility to achieve a full thickness excision of the rectal wall. TEM also allows the identification of any residual disease and provides optimal quality of life and functional results.

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Author contributions

Roberto Ghiselli contributed substantially to the conception and design of the study. Monica Ortenzi organized the data collection process, developed and led the project and prepared the manuscript. Luca Cardinali contributed to the acquisition and analysis of the data. Rosaria Gesuita and Edlira Skramy participated in the interpretation of the data for the study and provided advice on statistics. Mario Guerrieri draughted the manuscript, revised it critically for important intellectual content and gave final approval of the version to be published.

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Authors and Affiliations

  1. Department of General Surgery, Università Politecnica delle Marche, 60126, Ancona, Italy

    Roberto Ghiselli, Monica Ortenzi, Luca Cardinali & Mario Guerrieri

  2. Interdepartmental “Epidemilogia, Biostatistica e Informatica Medica (EBI)” Centre, Università Politecnica delle Marche, 60126, Ancona, Italy

    Edlira Skrami & Rosaria Gesuita

Authors
  1. Roberto Ghiselli
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  2. Monica Ortenzi
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Corresponding author

Correspondence to Monica Ortenzi.

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Disclosures

Roberto Ghiselli, Monica Ortenzi, Luca Cardinali, Edlira Skrami, Rosaria Gesuita and Mario Guerrieri have no conflicts of interest or financial ties to disclose.

Additional information

The paper is based on a previous communication to the EAES annual meeting held in Amsterdam the 15th–18th of June 2016.

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Ghiselli, R., Ortenzi, M., Cardinali, L. et al. Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy. Surg Endosc 31, 2997–3003 (2017). https://doi.org/10.1007/s00464-016-5321-z

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  • DOI: https://doi.org/10.1007/s00464-016-5321-z

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