Functional Outcomes After Local Excision for Rectal Neoplasia

  • Elizabeth R. Raskin


Transanal surgery is a viable option for most benign and select malignant rectal neoplasms. While a large focus has been placed on the safety, feasibility, and oncologic soundness of transanal techniques compared to traditional proctectomy, functional outcomes following transanal surgery have received much less attention. This chapter aims to define anorectal function, elucidate preoperative and intraoperative factors that contribute to functional outcomes, and compare postoperative outcomes after traditional transanal surgery, transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS). The insertion and utilization of either an anoscope or a minimally invasive platform can affect the sphincter complex and potentially cause postoperative dysfunction. Careful consideration to preoperative functional status should be paid to avoid exacerbation of existing continence issues and for setting appropriate expectations for potential disturbances in continence and quality of life in the postoperative setting. Size of tumor, location within the rectum, extent of resection, duration of surgery, age, and female sex have been postulated to affect functional outcomes; however, no strong data exist to uniformly vilify any preoperative or intraoperative factor. The sole exception: Patients who have received chemoradiation therapy prior to transanal excision have been shown to have an elevated risk for postoperative anorectal dysfunction. While injury to the sphincter complex and rectal wall is possible during transanal excisional surgery, the majority of continence and quality of life data demonstrates acceptable results and supports the use of transanal surgical approaches over traditional proctectomy when oncologically appropriate.


Local excision Rectal neoplasia Transanal surgery Anorectal function Transanal endoscopic microsurgery Transanal minimally invasive surgery 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elizabeth R. Raskin
    • 1
    • 2
  1. 1.Loma Linda UniversityLoma LindaUSA
  2. 2.VA Hospital Loma Linda, Department of SurgeryLoma LindaUSA

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