Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
Tech Coloproctol. 2021 Apr;25(4):449-459. doi: 10.1007/s10151-020-02397-1. Epub 2021 Mar 1.
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.
本研究旨在评估经肛门全直肠系膜切除术（TaTME）与传统腹腔镜全直肠系膜切除术（TME）相比，在术后 3 个月和 12 个月时对健康相关生活质量（HRQoL）、肠功能和性功能的短期和中期影响。
对 2014 年 11 月至 2018 年 12 月期间在我院接受传统腹腔镜 TME 和 TaTME 的连续患者进行前瞻性研究。采用欧洲癌症研究与治疗组织结直肠癌特定模块生命质量问卷（EORTC-QLQ-CR29）、国际勃起功能指数（IIEF-5）、女性性功能指数（FSFI）、低位前切除综合征（LARS）评分和 Wexner 评分等经验证的量表评估 HRQoL 和肠功能。通过倾向评分匹配对患者进行一对一匹配。比较 3 个月和 12 个月时问卷的结果。
共纳入 60 例患者。其中，传统腹腔镜组 30 例（男 13 例；中位年龄 69.3 岁[范围 35-80 岁]），TaTME 组 30 例（男 14 例；中位年龄 75.6 岁[范围 42-83 岁]）。在回肠造口关闭后 3 个月，TaTME 组患者的臀部疼痛（p = 0.030）、腹胀（p = 0.023）、排便频率（p = 0.013）、排气（p < 0.001）和粪便失禁（p = 0.044）更明显，但这些差异在 12 个月时均未持续存在。TaTME 组患者的总体 LARS 评分在 3 个月时更高（p = 0.032），但 12 个月时无差异。在 TaTME 治疗后 12 个月，女性患者的女性性兴趣（p = 0.039）和性交困难评分（p < 0.001）更好，而男性患者的勃起功能（p = 0.038）更好。其他量表在 3 个月和 12 个月时组间均无显著差异。
与接受传统腹腔镜 TME 治疗的中低位直肠癌患者相比，接受 TaTME 治疗的患者在初次切除后的短期内在 HRQoL 和肠功能方面表现较差，但在长期内似乎具有更好的性功能。
