TY - JOUR
T1 - Functional Outcomes after Transanal Total Mesorectal Excision (taTME) for Rectal Cancer
T2 - Results from the Phase II North American Multicenter Prospective Observational Trial
AU - Donovan, Katherine F.
AU - Lee, Katherine C.
AU - Ricardo, Alison
AU - Berger, Natalie
AU - Bonaccorso, Antoinette
AU - Alavi, Karim
AU - Zaghiyan, Karen
AU - Pigazzi, Alessio
AU - Sands, Dana
AU - Debeche-Adams, Teresa
AU - Chadi, Sami A.
AU - McLemore, Elisabeth C.
AU - Marks, John H.
AU - Maykel, Justin A.
AU - Shawki, Sherief F.
AU - Steele, Scott R.
AU - Albert, Matthew
AU - Whiteford, Mark H.
AU - Cheng, Fu Yuan
AU - Wexner, Steven D.
AU - Sylla, Patricia
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/9/1
Y1 - 2024/9/1
N2 - Objective: To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME). Background: 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. Methods: 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)]. Results: 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. Conclusions: 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.
AB - Objective: To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME). Background: 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. Methods: 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)]. Results: 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. Conclusions: 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.
KW - functional outcomes
KW - patient-reported outcomes
KW - quality of life
KW - rectal cancer
KW - transanal total mesorectal excision
UR - http://www.scopus.com/inward/record.url?scp=85200867612&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006374
DO - 10.1097/SLA.0000000000006374
M3 - Article
C2 - 38869440
AN - SCOPUS:85200867612
SN - 0003-4932
VL - 280
SP - 363
EP - 373
JO - Annals of Surgery
JF - Annals of Surgery
IS - 3
ER -