Patient-reported functional and quality-of-life outcomes after transanal total mesorectal excision

Background: Impaired function after low anterior resection (LAR) is common and affects quality of life (QoL). Transanal total mesorectal excision (TaTME) may alter functional outcomes but patient-reported outcomes are scarce. This study assessed functional outcomes and QoL after TaTME for rectal cancer. Methods: Functional outcomes and QoL data from two International Transanal TME Registry centres were reviewed for consecutive patients with rectal cancer undergoing restorative LAR with TaTME. Endpoints were QoL (EuroQol Five Dimensions, European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires), urogenital function (International Prostate Symptom Score, 5-item version of International Index of Erectile Function questionnaire and abbreviated McCoy Female Sexuality Function Questionnaire) and bowel function (low anterior resection syndrome (LARS) bowel and Vaizey continence scores) from self-reported surveys before and 12–24 months after definitive surgery. Results: Of 61 patients evaluated (82 per cent men), one-quarter were obese and 44 per cent had neoadjuvant chemoradiotherapy. All tumours were mid-to-low rectal, with the anastomosis a mean 3·93 cm from the anal verge. Follow-up after 12–24 months revealed improved general QoL and emotional function, with preserved urinary, bowel and sexual function. Although 31 per cent reported major LARS, this was comparable to preoperative scores and patients reported good QoL. Regression analysis showed that urinary and bowel functional outcomes did not influence overall QoL; better erectile function was associated with enhanced QoL. Longer transanal operating time was associated with worse LARS. Conclusion: Follow-up of at least 1 year after TaTME demonstrated improved QoL and stable or improved functional outcomes.