Quality of Life after Transanal Total Mesorectal Excision - A Single-Center Study

Abstract

Introduction: Transanal total mesorectal excision (TaTME) has been used as a surgical technique for rectal cancer treatment for over a decade now. The bottom-up dissection provides a better view of the pelvic sensory nerve fibers, which theoretically could lead to better nerve preservation, hence better functional outcomes. Nevertheless, concerns about worsening of the functional results due to low anastomosis and sphincter damage caused by the platform have been raised. There is no clear data showing advantage or disadvantage of TaTME compared to robotic total mesorectal excision (rTME) or laparoscopic TME in terms of functional results. This study aims to present single-center data on quality of life (QoL) after TaTME. Material and Methods: A single-center prospective study on the quality of life after the first 16 consecutive cases of TaTME from July 2019 to June 2021 was conducted. Quality of life (QoL) was assessed with a questionnaire. A total of 13 patients were analyzed by EuroQol-5D (EQ-5D), EORTC QLQ-C30, EORTC QLQ-CR29, IPSS, LARS and Vaizey scores 1-9. Quality of Life data collection was done according to the following algorithm: (a) In patients without a stoma -preoperatively, at 3, 6, and 12 months, and annually thereafter; (b) in patients with a stoma -preoperatively, at 3 months postoperatively (if there was no stoma reversal), and after stoma reversal at 3, 6, and 12 months, and annually thereafter. All procedures were performed by the same team. Results: A total of 13 patients completed the questionnaires preoperatively and at least once postoperatively. Statistically significant improvement was found in the following parameters postoperatively compared with preoperative levels: EuroQol-5D pain/discomfort (p=0.014); physical functioning (p=0.046), financial problems (p=0.025); global health in QLQ-C30 (p=0.001), degree of anxiety/depression in QLQ-CR29 (p=0.020), specific quality of life in the IPSS questionnaire (p=0.011). No statistical differences were found in: the visual analogue self-reported health scale in EuroQol-5D (p=0.114); social functioning in the QLQ-C30 (p=0.705); fecal incontinence for patients without a stoma in QLQ-CR29 (p=0.317); degree of LARS (p=0.763); Vaziey score (p=0.782). Conclusion: quality of life after TaTME seems promising, large, well-structured trials in the scientific area are needed.