Doornebosch P G, Tollenaar R A E M, Gosselink M P, Stassen L P, Dijkhuis C M, Schouten W R, van de Velde C J, de Graaf E J R
Department of Surgery, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Colorectal Dis. 2007 Jul;9(6):553-8. doi: 10.1111/j.1463-1318.2006.01186.x.
Total mesorectal excision (TME) is the gold standard in rectal cancer, if curation is intended. Transanal endoscopic microsurgery (TEM) is a much safer technique and seems to have comparable survival in early rectal cancer. The impact of both procedures on quality of life has never been compared. In this study we compared quality of life after TEM and TME.
Fifty-four patients underwent TEM for a T1 carcinoma. Only patients without known locoregional or distant recurrences were included, resulting in 36 eligible patients in whom quality of life after TEM was studied. The questionnaires used included the EuroQol EQ-5D, EQ-VAS, EORTC QLQ-C30 and EORTC QLQ-CR38. The results were compared with a sex-and age-matched sample of T+N0 rectal cancer patients who had undergone sphincter saving surgery by TME and a sex- and age matched community-based sample of healthy persons.
Thirty-one patients after TEM returned completed questionnaires (overall response rate 86%). Quality of life was compared with 31 TME patients and 31 healthy controls. From the patients' and social perspective quality of life did not differ between the three groups. Compared with TEM, significant defecation problems were seen after TME (P < 0.05). A trend towards better sexual functioning after TEM, compared with TME, was seen, especially in male patients, although it did not reach statistical significance.
Transanal endoscopic microsurgery and TME do not seem to differ in quality of life postoperatively, but defecation disorders are more frequently encountered after TME. This difference could play a role in the choice of surgical therapy in (early) rectal cancer. Further prospective studies are needed to confirm our conclusions.
如果旨在进行根治性治疗，全直肠系膜切除术（TME）是直肠癌治疗的金标准。经肛门内镜显微手术（TEM）是一种更安全的技术，在早期直肠癌中似乎具有相当的生存率。从未比较过这两种手术对生活质量的影响。在本研究中，我们比较了TEM和TME术后的生活质量。
54例患者因T1期癌接受TEM治疗。仅纳入无已知局部或远处复发的患者，最终有36例符合条件的患者纳入研究，对其TEM术后的生活质量进行研究。使用的问卷包括欧洲五维健康量表（EuroQol EQ-5D）、EQ视觉模拟量表（EQ-VAS）、欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）和欧洲癌症研究与治疗组织直肠癌特异性问卷（EORTC QLQ-CR38）。将结果与年龄和性别匹配的T+N0期直肠癌患者样本（这些患者通过TME进行了保肛手术）以及年龄和性别匹配的基于社区的健康人样本进行比较。
31例TEM术后患者返回了完整问卷（总体回复率86%）。将生活质量与31例TME患者和31例健康对照进行比较。从患者和社会角度来看，三组之间的生活质量没有差异。与TEM相比，TME术后出现了明显的排便问题（P<0.05）。与TME相比，TEM术后性功能有改善的趋势，尤其是男性患者，尽管未达到统计学意义。
经肛门内镜显微手术和TME术后生活质量似乎没有差异，但TME术后排便障碍更常见。这种差异可能在（早期）直肠癌手术治疗的选择中起作用。需要进一步的前瞻性研究来证实我们的结论。
