Quality of Life After Surgery for Rectal Cancer: a Comparison of Functional Outcomes After Transanal and Laparoscopic Approaches

Abstract

Background: The aim in rectal cancer surgery is to cure with minimal impact on the quality of life. Transanal total mesorectal excision (TaTME) seems to be a safe and feasible alternative to laparoscopic TME (LaTME). However, limited data are available on the functional outcomes after TaTME. We aimed to study the quality of life (QoL), through questionnaires, comparing different functional outcomes after TaTME and LaTME.

Methods: Consecutive patients who underwent TME between 2010 and 2017 at Slagelse Hospital, Denmark, were included based on certain criteria. Patients were divided according to the surgical technique (TaTME vs LaTME). The study was based on telephone interviews using the questionnaires: EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome (LARS) score, and International Prostate Symptom Score (IPSS) for male patients. Patients in this study had a follow-up time of at least 8 months.

Results: Overall, global health status was similar between the groups (p = 0.625). Anorectal symptoms were significantly in disfavor of TaTME including buttock pain (p = 0.011), diarrhea (p = 0.009), clustering of stools (p = 0.017), and urgency (p = 0.032), yet total LARS score was comparable (p = 0.054). We found comparable sexual results and an overall higher satisfaction with urinary status in TaTME group (p = 0.010), yet no difference in IPSS symptoms (p = 0.236).

Conclusions: Anorectal dysfunction may occur after total mesorectal excision (TME) regardless of surgical technique, frequently more in after TaTME. The LARS symptoms and the overall quality of life status were however comparable. TaTME had a positive impact on the reported QoL, related to urinary symptoms.

Keywords: Functional results; LaTME; Quality of life; Rectal cancer; Surgery; TaTME.