A prospective study ofhealth related quality of life, bowel and sexualfunction after TaTME and conventional laparoscopic TME for mid and low rectal cancer.

Abstract

The aim of our study was to evaluate short-term (3 months) and medium-term (12 months)postoperative effects on health related quality of life (HRQoL), bowel and sexualfunction after transanal total mesorectal excision (TaTME) in comparison with conventional laparoscopic total mesorectal excision (TME). A prospectivestudy was conducted on consecutive patients who had conventional laparoscopic TME and TaTME at our institution from November 2014 to December 2018.We evaluated HRQoL and bowel function using validated scales including the European Organization for Research and Treatment of Cancer Quality of Life of colorectal cancer specific module (EORTC-QLQ-CR29), International Index of Erectile Function (IIEF-5), Female Sexual Function Index (FSFI), low anterior resection syndrome (LARS) score and Wexner score. Patients were matched one-to-one through propensity score matching. Outcomes of the questionnaires at 3 and 12months were compared. Sixty patients were enrolled in the study. There were 30 in the conventional laparoscopic group (13 males; median age 69.3years [range 35-80years]) and 30 in the TaTME group (14 males; median age 75.6years [range 42-83years]). Three months after ileostmy closure, patients in the TaTME group had significantly morebuttock pain(p = 0.030), bloating(p = 0.023), stool frequency(p = 0.013), flatulence(p < 0.001) and fecal incontinence(p = 0.044),although none of these differences persisted at 12 months. Patients in the TaTME group had a higher median overall LARS scoreat 3 months (p = 0.032)but there was no difference at 12 months. At 12months after TaTME female patients had better women's sexual interest (p = 0.039) and dyspareunia scores (p < 0.001), while male patients had better erectile function (p = 0.038). Other scales did not reveal a significant difference at either 3 of12months between groups. Compared with patients with mid and low rectal cancer treated with conventional laparoscopic TME, those treated with TaTME have worse HRQoL and bowel function for a short period after primary resection, but seem to have better sexual function in the long term.