Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY.
Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA.
Ann Surg. 2024 Sep 1;280(3):363-373. doi: 10.1097/SLA.0000000000006374. Epub 2024 Jun 13.
To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME).
Proctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter phase II taTME trial demonstrated the safety of taTME in patients with stage I to III tumors.
Prospectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence [Fecal Incontinence Quality of Life (FIQL), Wexner], defecatory function [Colorectal Functional Outcome (COREFO)], urinary function (International Prostate Symptom Score), and sexual function (Female Sexual Function Index-female, International Index of Erectile Function-male) were assessed preoperatively (PQ), 3 to 4 months postileostomy closure (FQ1), and 12 to 18 months post-taTME [postoperative questionnaire 2 (FQ2)].
Among 83 patients who responded at all 3 time points, FIQL, Wexner, and COREFO significantly worsened postileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. International Prostate Symptom Score did not change relative to preoperative scores. For females, Female Sexual Function Index declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, International Index of Erectile Function declined with no change between FQ1 and FQ2.
Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decision-making regarding taTME.
研究经肛门全直肠系膜切除术（taTME）后粪便失禁和排便、泌尿和性功能的结果。
直肠癌根治术可能导致排便、泌尿和性功能改变，这些改变在 12 个月后仍持续存在。最近的多中心 II 期 taTME 试验证明了 taTME 在 I 至 III 期肿瘤患者中的安全性。
前瞻性登记的自我报告问卷收集了 100 例 taTME 患者的数据。粪便失禁[粪便失禁生活质量（FIQL），Wexner]、排便功能[结直肠功能结局（COREFO）]、泌尿功能（国际前列腺症状评分）和性功能（女性性功能指数-女性，男性国际勃起功能指数）在术前（PQ）、造口关闭后 3 至 4 个月（FQ1）和 taTME 后 12 至 18 个月[术后问卷 2（FQ2）]进行评估。
在所有 3 个时间点都有反应的 83 例患者中，FIQL、Wexner 和 COREFO 在造口关闭后显著恶化。在 FQ1 和 FQ2 之间，FIQL 生活方式和应对、Wexner 和 COREFO 失禁、社会影响、频率和需要药物治疗显著改善，而 FIQL 抑郁和尴尬没有变化。国际前列腺症状评分与术前评分相比没有变化。对于女性，在 PQ 和 FQ1 之间，女性性功能指数的欲望、 orgasm 和满意度下降，在 FQ1 和 FQ2 之间没有改善。对于男性，国际勃起功能指数下降，FQ1 和 FQ2 之间没有变化。
尽管 taTME 导致排便功能和粪便失禁初始下降，但在造口关闭后 12 个月，大多数功能域得到改善，没有恢复到术前状态。在 taTME 后 18 个月时，性功能下降且没有改善，而泌尿功能保持不变。我们的结果满足了患者的期望，并为 taTME 提供了共享决策信息。
