Functional Outcomes and Quality of Life After Transanal Total Mesorectal Excision For Rectal Cancer: A Prospective Observational Study.

Background Few studies have addressed the functional impact after transanal total mesorectal excision. Objective To evaluate function and health-related quality of life among patients with rectal cancer treated with transanal total mesorectal excision. Design Consecutive patients treated between 2016 and 2018 were selected. Their function and quality of life was studied preoperatively, at 3 and 12 months after surgery. Setting Prospective case series. Patients Patients were eligible if they had primary anastomosis, the diverting stoma had been reversed, and in the absence of anastomotic leakage. Forty-five patients were finally included. A total of 31 (68.8%) and 32 patients (71.1%) completed the 3- and 12-months surveys, respectively. Interventions Standard transanal total mesorectal excision. Main outcome measures The primary endpoint was functional and quality of life outcomes using validated questionnaires. Secondary endpoints included values obtained with endoanal ultrasounds, anorectal manometries, and rectal sensation testing. Results Wexner and Low Anterior Resection scores significantly increased 3 months after surgery but returned to baseline values at 12 months. The rate of major Low Anterior Resection Syndrome at the end of follow-up was 25.0% (+11.7% compared to baseline, p=0.314). Sexual and urinary functions remained stable throughout the study, although a meaningful clinical improvement was detected in male sexual interest. Among quality of life domains, all deteriorations returned to baseline values 12 months after surgery, except worsening of flatulence symptoms, and improvement in insomnia and constipation. At 12 months, an expected decrease in the mean width of the internal sphincter, the anal resting pressure, and the tenesmus threshold volume was found. Limitations Limited sample size, absence of a comparative group, significant missing data in female sexual difficulty, and in ultrasounds and manometries at 3 months. Conclusions Patients undergoing transanal total mesorectal excision report acceptable quality of life and functional outcomes 12 months after surgery. See Video Abstract at http://links.lww.com/DCR/B541.