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 sexual function after transanal total mesorectal excision (TaTME) in comparison with conventional laparoscopic total mesorectal excision (TME).
A prospective study 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 12 months were compared.
Sixty patients were enrolled in the study. There were 30 in the conventional laparoscopic group (13 males; median age 69.3 years [range 35-80 years]) and 30 in the TaTME group (14 males; median age 75.6 years [range 42-83 years]). Three months after ileostmy closure, patients in the TaTME group had significantly more buttock 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 score at 3 months (p = 0.032) but there was no difference at 12 months. At 12 months 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 of 12 months 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.