Functional Outcomes after Transanal Surgery

Abstract

Transanal surgery has gained in popularity during the latter part of the last decade for both rectal cancer and benign disease. The current role for local excision of early rectal neoplastic lesions has expanded due to better understanding of risk factors for lymph node metastasis and heightened awareness for the long-term sequelae of radical surgery. Transanal resection of the rectum (both for cancer or inflammatory bowel diseases) has now been established as a successful procedure that overcomes some of the limitations of the abdominal approaches. Once the feasibility, safety, and the oncologic results of transanal minimally invasive approaches for patients with rectal cancer have been acknowledged, quality of life and functional outcomes have become increasingly important issues. This article provides an overview of the different techniques currently available for the minimally invasive transanal treatment of rectal lesions, particularly focusing on functional outcomes.

Keywords

rectal cancer - transanal endoscopic surgery - minimally invasive surgery - TaTME

^* These authors contributed equally to this study.

Publication History

Article published online:
28 February 2022

• References

• 1 Plummer JM, Leake PA, Albert MR. Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery. World J Gastrointest Surg 2017; 9 (06) 139-148
• 2 Sevak S, Gregoir T, Wolthuis A, Albert M. How can we utilize local excision to help, not harm, geriatric patients with rectal cancer?. Eur J Surg Oncol 2020; 46 (03) 344-348
• 3 Hompes R, Penna M. Summary of oncologic and functional outcomes. Clin Colon Rectal Surg 2020; 33 (03) 150-156
• 4 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
• 5 Rockwood TH, Church JM, Fleshman JW. et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 1999; 42 (12) 1525-1532
• 6 Rockwood TH, Church JM, Fleshman JW. et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43 (01) 9-16 , discussion 16–17
• 7 Young DO, Kumar AS. Local excision of rectal cancer. Surg Clin North Am 2017; 97 (03) 573-585
• 8 Rullier E, Rouanet P, Tuech J-J. et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet 2017; 390: 469-79.21
• 9 Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg 1991; 78 (12) 1429-1430
• 10 MacDonald A, Smith A, McNeill AD, Finlay IG. Manual dilatation of the anus. Br J Surg 1992; 79 (12) 1381-1382
• 11 Allaix ME, Arezzo A, Nestorović M, Galosi B, Morino M. Local excision for rectal cancer: a minimally invasive option. Minerva Chir 2018; 73 (06) 548-557
• 12 Marinello FG, Curell A, Tapiolas I, Pellino G, Vallribera F, Espin E. Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution. Int J Colorectal Dis 2020; 35 (01) 51-67
• 13 Goldenshluger M, Gutman Y, Katz A, Schtrechman G, Westrich G, Nissan A, Segev L. Long-Term Bowel Function after Transanal Minimally Invasive Surgery (TAMIS). Isr Med Assoc J 2020 Jul;22(7):426-430. PMID: 33236567
• 14 Lacy AM, Tasende MM, Delgado S. et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 2015; 221 (02) 415-423
• 15 Penna M, Hompes R, Arnold S. et al; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 2017; 266 (01) 111-117
• 16 Maurer CA. Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res 2005; 165: 196-204
• 17 Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E. A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 2002; 131 (04) 368-372
• 18 Quah HM, Jayne DG, Eu KW, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 2002; 89 (12) 1551-1556
• 19 Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Yun SH. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg 2014; 38 (07) 1834-1842
• 20 Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery?. Colorectal Dis 2016; 18 (01) 19-36
• 21 Araujo SE, Crawshaw B, Mendes CR, Delaney CP. Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 2015; 19 (02) 69-82
• 22 Penna M, Hompes R, Arnold S. et al; International TaTME Registry Collaborative. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg 2019; 269 (04) 700-711
• 23 Penna M, Knol JJ, Tuynman JB, Tekkis PP, Mortensen NJ, Hompes R. Four anastomotic techniques following transanal total mesorectal excision (TaTME). Tech Coloproctol 2016; 20 (03) 185-191
• 24 Francis N, Penna M, Mackenzie H, Carter F, Hompes R. International TaTME Educational Collaborative Group. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 2017; 31 (07) 2711-2719
• 25 Rouanet P, Mourregot A, Azar CC. et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 2013; 56 (04) 408-415
• 26 Rouanet P, Saint-Aubert B, Lemanski C. et al. Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results. Dis Colon Rectum 2002; 45 (03) 305-313 , discussion 313–315
• 27 Tuech JJ, Karoui M, Lelong B. et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 2015; 261 (02) 228-233
• 28 Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 2016; 30 (11) 4924-4933
• 29 Koedam TW, van Ramshorst GH, Deijen CL. et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 2017; 21 (01) 25-33
• 30 Veltcamp Helbach M, Koedam TWA, Knol JJ. et al. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 2019; 33 (01) 79-87
• 31 Bjoern MX, Nielsen S, Perdawood SK. Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg 2019; 23 (08) 1623-1630
• 32 Bjoern MX, Perdawood SK. Manometric assessment of anorectal function after transanal total mesorectal excision. Tech Coloproctol 2020; 24 (03) 231-236
• 33 Rubinkiewicz M, Zarzycki P, Witowski J. et al. Functional outcomes after resections for low rectal tumors: comparison of transanal with laparoscopic total mesorectal excision. BMC Surg 2019; 19 (01) 79
• 34 Keller DS, Reali C, Spinelli A. et al. Patient-reported functional and quality-of-life outcomes after transanal total mesorectal excision. Br J Surg 2019; 106 (04) 364-366
• 35 Chandrasinghe P, Carvello M, Wasmann K. et al. Transanal ileal pouch-anal anastomosis for ulcerative colitis has comparable long-term functional outcomes to transabdominal approach: a multicentre comparative study. J Crohn's Colitis 2020; 14 (06) 726-733