Page 42 - Read Online

De Nardi. Mini-invasive Surg 2018;2:20 I http://dx.doi.org/10.20517/2574-1225.2018.30 Page 5 of 7

Table 1. Studies evaluating function and QoL in taTME
No. of
Studies patients Tumor characteristics Function Instruments Time of evaluation
Rouanet et al. [37] , 2013 21 Advanced or recurrent cancer, FI WS 12 months after stoma
complex anatomy or tumor closure
Atallah et al. [39] , 2014 20 Low, mid locally advanced or FI telephone survey 8 weeks after stoma
distal rectal cancer + complex closure
anatomy
Elmore et al. [38] , 2015 6 Low, mid rectal cancer FI WS Pre-operation,
6 months post
Kneist et al. [41] , 2016 10 Low rectal cancer, colo-anal Bowel, urinary, IPSS, IIEF, FSFI, LARS, Pre-operation ,
anastomosis or partial inter- sexual functions, RUV, WS, QoL index 3, 6, 9 months post-
sphincteric resection QoL operation
[15]
Koedam et al. , 2017 30 Any rectal cancer, with primary Bowel, urinary, EQ-5D, QLQ-C30 Pre-operation,
anastomosis sexual functions, QLQ-CR29, LARS 1, 6 months post-opera-
QoL tion
Borreca et al. [36] , 2015 18* Any rectal cancer FI WS Post operation
Tuech et al. [40] , 2015 52 Low rectal cancer, colo-anal Bowel, urinary, WS, interview Post operation
anastomosis or intersphincteric sexual (male)
resection function
*Total number of patients, only patients who had their stoma closed were evaluated but the number is not reported. WS: Jorge-Wexner
score; IPSS: international prostate symptom score; IIEF: international index of erectile function; FSFI: female sexual function index; LARS:
low anterior resection syndrome score; FI: fecal incontinence; QoL: quality of life; taTME: transanal total mesorectal excision

had major LARS but no colostomies were required. Both the overall QoL and the colorectal cancer specific
QoL score significatively decreased one month after surgery, but most outcomes returned to baseline after
6 months, except for social function and anal pain. Urinary symptoms, incontinence, increased frequency
or dysuria, did not change significantly after taTME. Sexual function significantly worsened at 1 month
postoperatively, but returned to the same level as before surgery at 6 months. The authors’ conclusion was
that taTME is associated with acceptable QoL and functional outcomes comparable with conventional
laparoscopic TME. Table 1 summarizes the articles dealing with functional results in taTME.

CONCLUSIONS
Given the limitations of the existing studies larger studies have been advocated. Several studies exploring
this novel surgical technique and the functional sequelae have been registered into clinicaltrial.gov, and
[48]
some of them are already recruiting patients. Among them the COLOR III trial , an international, mul-
ticentre, randomized trial, is expected to enrol more than 1000 patients in 4 years. In addition to clinical
and oncological parameters, quality of life and functional outcomes will be assessed at 1, 3, 6, 12, 24 and
36 months after surgery by means of specific questionnaires.

In conclusion, published data concerning anorectal function, urinary and sexual function, and quality
of life after taTME are still scarce and comparative data are lacking. Based on the few available studies,
taTME does not seem to substantially impair functional and quality of life outcomes when compared to
laparoscopic abdominal TME. However further studies are needed to confirm these results; the ongoing
studies and particularly the COLOR III trial, will hopefully provide more firm updates for a more accurate
assessment of this promising technique.

DECLARATIONS
Author’s contribution
The author solely contributed to the article.

Availability of data and materials
Not applicable.