Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer

John H. Marks, Jean F. Salem, Elsa B. Valsdottir, Shadi Yarandi, Gerald J. Marks

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)258-265
Number of pages8
JournalDiseases of the Colon and Rectum
Volume60
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Rectal Neoplasms
Quality of Life
Neoplasms
Patient Satisfaction
Fecal Incontinence
Colostomy
Selection Bias
Body Image
Anal Canal
Rectum
Tertiary Care Centers
Life Style
Reference Values
Cross-Sectional Studies
Outcome Assessment (Health Care)
Organizations

Keywords

  • Colo-anal anastomosis
  • Quality of life
  • Rectal cancer
  • Sphincter-preserving surgery
  • Total mesorectal excision
  • Transanal abdominal transanal
  • Transanal total mesorectal excision

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer. / Marks, John H.; Salem, Jean F.; Valsdottir, Elsa B.; Yarandi, Shadi; Marks, Gerald J.

In: Diseases of the Colon and Rectum, Vol. 60, No. 3, 01.03.2017, p. 258-265.

Research output: Contribution to journalArticle

Marks, John H. ; Salem, Jean F. ; Valsdottir, Elsa B. ; Yarandi, Shadi ; Marks, Gerald J. / Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer. In: Diseases of the Colon and Rectum. 2017 ; Vol. 60, No. 3. pp. 258-265.
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AU - Marks, Gerald J.

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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.

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KW - Transanal total mesorectal excision

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