TY - JOUR
T1 - Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer
AU - Marks, John H.
AU - Salem, Jean F.
AU - Valsdottir, Elsa B.
AU - Yarandi, Shadi S.
AU - Marks, Gerald J.
N1 - Publisher Copyright:
© The ASCRS 2016.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant. Objective: The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy. Design: This is a cross-sectional study. Settings: The study was conducted at a tertiary referral colorectal center. Patients: Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life. Main Outcome Measures: Quality of life, functional outcomes, and patient satisfaction were measured and compared by age, tumor level, and stage of the disease. Results: A total of 133 surveys were mailed, and 90 patients responded and were included in the study. Patient quality of life was not significantly different after surgery. Patients with more proximal tumors had better lifestyle, physical, and emotional scores. Older patients performed better on multiple levels, including coping, emotional, body image, future perspective, and digestive. Stage of disease had no impact on quality of life. Compared with reference values, patients who underwent transanal abdominal transanal proctectomy performed better on most of the components. All of patients preferred transanal abdominal transanal proctectomy over having a stoma based on their current anal sphincter function, and >97% of patients preferred transanal abdominal transanal proctectomy based on their current quality of life, sexual function, and level of activities. Limitations: This study is limited by the lack of a comparison group and a potential selection bias. Conclusions: Satisfaction with quality of life and functional outcomes is high after transanal abdominal transanal proctectomy. Older patients and those with more proximal tumors performed better. This patient population clearly preferred a sphincter-preserving option for treatment of their rectal cancer.
AB - Background: Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant. Objective: The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy. Design: This is a cross-sectional study. Settings: The study was conducted at a tertiary referral colorectal center. Patients: Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life. Main Outcome Measures: Quality of life, functional outcomes, and patient satisfaction were measured and compared by age, tumor level, and stage of the disease. Results: A total of 133 surveys were mailed, and 90 patients responded and were included in the study. Patient quality of life was not significantly different after surgery. Patients with more proximal tumors had better lifestyle, physical, and emotional scores. Older patients performed better on multiple levels, including coping, emotional, body image, future perspective, and digestive. Stage of disease had no impact on quality of life. Compared with reference values, patients who underwent transanal abdominal transanal proctectomy performed better on most of the components. All of patients preferred transanal abdominal transanal proctectomy over having a stoma based on their current anal sphincter function, and >97% of patients preferred transanal abdominal transanal proctectomy based on their current quality of life, sexual function, and level of activities. Limitations: This study is limited by the lack of a comparison group and a potential selection bias. Conclusions: Satisfaction with quality of life and functional outcomes is high after transanal abdominal transanal proctectomy. Older patients and those with more proximal tumors performed better. This patient population clearly preferred a sphincter-preserving option for treatment of their rectal cancer.
KW - Colo-anal anastomosis
KW - Quality of life
KW - Rectal cancer
KW - Sphincter-preserving surgery
KW - Total mesorectal excision
KW - Transanal abdominal transanal
KW - Transanal total mesorectal excision
UR - http://www.scopus.com/inward/record.url?scp=85013155768&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013155768&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000000762
DO - 10.1097/DCR.0000000000000762
M3 - Article
C2 - 28177987
AN - SCOPUS:85013155768
SN - 0012-3706
VL - 60
SP - 258
EP - 265
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 3
ER -