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One-year evaluation of anorectal functionality and quality of life in patients affected by mid-to-low rectal cancer treated with transanal total mesorectal excision

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Abstract

Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have investigated long-term functional outcomes and patients’ quality of life. The aim of this study was to compare functional outcomes and quality of life before and after transanal total mesorectal excision in 1-year follow-up. Between February 2016 and April 2019, 51 patients with mid- or low rectal cancer undergoing transanal total mesorectal excision at Fondazione Policlinico Universitario “A. Gemelli” were enrolled. Neoadjuvant radiochemotherapy was administered to locally advanced cancers. Before and after the surgical procedure, patients were examined collecting clinical data, LARS score, CCFIS, SF36 and FIQL, performing anorectal manometry and endoanal ultrasonography. Thirty-three patients were eligible and completed the 12 months follow-up. After treatment, six patients (18.2%) had minor or major LARS. A mild but significant increase of CCFIS was documented. Only the mean resting pressure significantly decreased at follow-up. No sphincter lesions were documented. FIQL assessment showed significant reduction of lifestyle, coping/behaviour, and embarrassment, while an increase of general health was assessed by SF36. At both uni- and multivariate analyses the neoadjuvant radiochemotherapy had a not negligible impact. Transanal total mesorectal excision represents a safe approach to patients treated for mid- or low rectal cancer. The functional sequelae can be limited in severity, with a low incidence of minor/major LARS, particularly faecal incontinence. These results are comparable to those obtained by the conventional total mesorectal excision.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Veronica De Simone, Francesco Litta, Angelo Parello, Paola Campennì, Raffaele Orefice, Angelo Marra, Alessandra Costa & Carlo Ratto

  2. General Surgery Department, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Roberto Persiani, Alberto Biondi & Domenico D’Ugo

Authors
  1. Veronica De Simone
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  2. Roberto Persiani
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  3. Alberto Biondi
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  4. Francesco Litta
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Contributions

VDS: substantial contributions to the conception or design of the work; acquisition, analysis and interpretation of data for the work. Drafting the work or revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RP, AB and CR contributed equally to this work: substantial contributions to the conception and design of the work; acquisition, analysis and interpretation of data for the work. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. FL, AP, PC, RO, AM and DD contributed equally to this work: substantial contributions to the acquisition of data for the work. Final approval of the version to be published. AC: substantial contributions to the conception or design of the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published.

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Correspondence to Veronica De Simone.

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The authors declare under their responsibility that all the procedures followed in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration.

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Informed consent was obtained from all patients for being included in the study.

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The datasets generated during the current study are available from the corresponding author on reasonable request.

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De Simone, V., Persiani, R., Biondi, A. et al. One-year evaluation of anorectal functionality and quality of life in patients affected by mid-to-low rectal cancer treated with transanal total mesorectal excision. Updates Surg 73, 157–164 (2021). https://doi.org/10.1007/s13304-020-00919-y

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