Transanal Endoscopic Microsurgery (TEMS) for Rectal Cancer: Patient Decision-making, Postoperative Experience and Quality of Life

Abstract

Background/aim: Transanal endoscopic microsurgery (TEMS) is a form of minimally invasive surgery for selected rectal cancers. The aim of this study was to explore the factors affecting patients' decision-making concerning the choice of surgical treatment as well as to measure the Quality of Life (QoL) post-TEMS.

Patients and methods: Thirty-four patients with rectal cancer stage T1/T2-N0-M0 that underwent TEMS were studied. The questionnaires used included the Short Form SF12v2, Wexner Score (CCF-FIS) and the Sexual Function Questionnaire (SFQ). The patients' views on experience and treatment decision were obtained with a custom-designed questionnaire. Questionnaires were completed at a mean of 6.9 years following treatment.

Results: The factors that influenced the patients' decisions were: experience satisfaction (p=0.003), postoperative bowel function (p<0.001), lower incontinence score (p=0.020) and agreement of TEMS experience with preoperative information (p=0.049). Treatment experience satisfaction was associated with family support (p=0.034) and agreement with preoperative information (p=0.047), better bowel function (p=0.026) and mental QoL (MCS) (p=0.003).

Conclusion: factors important to patients when reflecting on treatment experience are adequate and reliable information, a good QoL and the presence of family support. Clinicians should incorporate those parameters in their practice when assisting patients in making a surgical treatment choice and provide informed consent on TEMS for rectal cancer.

Keywords: Decision-making; QoL; TEMS; geriatric; incontinence; rectal cancer; sexual functioning.

Figure 1. Process of data collection.

Figure 2. Factors reflecting on decision satisfaction and their interrelations with treatment experience and QoL. Decision: “Would you have the TEMS surgery again in a similar situation?” Agreement Experience and Info: “Was your experience after TEMS in accordance with what was told to you beforehand?” Family support: “Did you feel you had the chance and enough time to digest the information and discuss with your family?” TEMS Experience: “Would you rate your experience from TEMS surgery as positive or negative on a scale of 0-10?”