Analysis of related factors affecting recovery of anal function after transanal total mesorectal excision_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FAN Yushi , YANG Bangcui ,  REN Mingyang , BAI Dan , HUANG Haixia , YANG Xuanhua , FU Zhiyong , LUO Binyu , LÜ Zhenbing

Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

REN Mingyang, Email: 2861746489@qq.com

Keywords：

rectal cancer; transanal total mesorectal excision; anal function; low anterior resection syndrome

DOI：

10.7507/1007-9424.202104029

Video：

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Objective To evaluate the postoperative anal function of rectal cancer patients treated with transanal total mesorectal excision (taTME), and to analyze the influencing factors which resulted in low anterior resection syndrome (LARS) after taTME in this paper, so as to provide guidance for clinical practice.Methods The data about the patients with rectal cancer treated with taTME were collected at the Affiliated Nanchong Central Hospital of North Sichuan Medical College from December 2018 to December 2019, including the clinical data and follow-up data. Postoperative recovery condition of the patients’ anal function and the affecting factors caused the occurrence of severe LARS after taTME were analyzed. The patients’ anal function within 1, 6, and 12 months after taTME were evaluated, and the evaluation tools were LARS scale and Wexner scale. The follow-up period was up to December 30, 2020.Results A total of 67 patients were completed preoperative and postoperative follow-up at 1, 6, and 12 months. In terms of anal function, within 1 month after taTME was the worst period in which the anal function was the worst among all the points of time evaluated (1.49±0.33, 10.28±0.64, 6.42±0.60, and 3.73±0.61, respectively), and there was time trend during the follow-up period (F=66.101, P<0.001). In the first year after taTME, the patient’s anal function was in a state of continuous recovery, and the differences between the three points of time at 1, 6, and 12 months after taTME and preoperative anal function were statistically significant (P<0.010). The results of multivariate analysis indicated that the distance between the anastomotic stoma and the anal verge was independent risk factor affecting the postoperative anal function of the patients with taTME at 1 month and 6 months (P<0.010).Conclusions With time going, the postoperative anal function of the patients with taTME can be recovered to a certain extent. The distance between the anastomotic stoma and the anal verge was the independent factor affecting the postoperative function of the rectal cancer patients received taTME.

Citation： FAN Yushi, YANG Bangcui, REN Mingyang, BAI Dan, HUANG Haixia, YANG Xuanhua, FU Zhiyong, LUO Binyu, LÜ Zhenbing. Analysis of related factors affecting recovery of anal function after transanal total mesorectal excision. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(12): 1569-1574. doi: 10.7507/1007-9424.202104029 Copy

1.	张忠涛, 郑民华, 姚宏伟, 等. 直肠癌经肛全直肠系膜切除专家共识及手术操作指南 (2017 版). 中国实用外科杂志, 2017, 37(9): 978-984.
2.	Ye J, Tian Y, Li F, et al. Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: A case matched study. Eur J Surg Oncol, 2021, 47(5): 1019-1025.
3.	Simo V, Tejedor P, Jimenez LM, et al. Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study. Surg Endosc, 2021, 35(4): 1808-1819.
4.	姚宏伟, 张忠涛, 郑民华. 直肠癌经肛全直肠系膜切除中国专家共识及临床实践指南 (2019 版). 中国实用外科杂志, 2019, 39(11): 1121-1128.
5.	中华人民共和国国家卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范 (2017 年版). 中国实用外科杂志, 2018, 38(10): 1089-1103.
6.	Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
7.	Meyer R, Alcalay M, Jamal R, et al. Validation of the Wexner scale in a Hebrew-speaking population. Int Urogynecol J, 2020, 31(12): 2583-2587.
8.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
9.	Keller DS, Berho M, Perez RO, et al. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol, 2020, 17(7): 414-429.
10.	Gardner IH, Kelley KA, Abdelmoaty WF, et al. Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population. Surg Endosc, 2021 Jan 8, [Epub ahead of print].
11.	Votava J, Kachlik D, Hoch J. Total mesorectal excision - 40 years of standard of rectal cancer surgery. Acta Chir Belg, 2020, 120(4): 286-290.
12.	Dittrich L, Biebl M, Schmuck R, et al. Initial experience with the safe implementation of transanal total mesorectal excision (TaTME) as a standardized procedure for low rectal cancer. J Clin Med, 2020, 10(1): 72.
13.	Shen Z, Yu G, Ren M, et al. Multicenter investigation of bowel evacuation function after transanal total mesorectal excision for mid-low rectal cancer. Int J Colorectal Dis, 2021, 36(4): 725-734.
14.	Koedam TW, van Ramshorst GH, Deijen CL, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol, 2017, 21(1): 25-33.
15.	叶志伟, 陈远光, 胡明, 等. 直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究. 中国普通外科杂志, 2015, 24(4): 473-477.
16.	Dulskas A, Smolskas E, Kildusiene I, et al. Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Colorectal Dis, 2018, 33(3): 251-260.
17.	Nguyen TH, Chokshi RV. Low anterior resection syndrome. Curr Gastroenterol Rep, 2020, 22(10): 48.
18.	马全民, 申占龙, 刘凡, 等. 经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后肛门功能的比较. 中华结直肠疾病电子杂志, 2018, 7(4): 337-341.
19.	Rubinkiewicz M, Zarzycki P, Witowski J, et al. Functional outcomes after resections for low rectal tumors: comparison of transanal with laparoscopic total mesorectal excision. BMC Surg, 2019, 19(1): 79.
20.	Pontallier A, Denost Q, Van Geluwe B, et al. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc, 2016, 30(11): 4924-4933.
21.	佟伟华, 何亮, 张路遥, 等. 腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌患者术后排便功能评价及其影响因素分析. 中华消化外科杂志, 2019, 18(8): 761-767.
22.	窦若虚, 孙伟鹏, 罗双灵, 等. 经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后患者的肠道功能: 基于随机临床研究的比较. 中华胃肠外科杂志, 2019, 22(3): 246-254.
23.	Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 29-42.
24.	Yang XH, Li KG, Wei JB, et al. Retrospective study of preoperative chemoradiotherapy with capecitabine versus capecitabine plus oxaliplatin for locally advanced rectal cancer. Sci Rep, 2020, 10(1): 12539.
25.	Kasi A, Abbasi S, Handa S, et al. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer: A systematic review and meta-analysis. JAMA Netw Open, 2020, 3(12): e2030097.
26.	Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer, 2015, 14(2): 106-114.
27.	袁凯涛, 马晋平. 直肠癌低位前切除术行预防性回肠末端造口是否影响直肠肛门功能—一项随访长达 12 年的随机多中心研究. 中华胃肠外科杂志, 2017, 20(9): 986.

1. 张忠涛, 郑民华, 姚宏伟, 等. 直肠癌经肛全直肠系膜切除专家共识及手术操作指南 (2017 版). 中国实用外科杂志, 2017, 37(9): 978-984.
2. Ye J, Tian Y, Li F, et al. Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: A case matched study. Eur J Surg Oncol, 2021, 47(5): 1019-1025.
3. Simo V, Tejedor P, Jimenez LM, et al. Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study. Surg Endosc, 2021, 35(4): 1808-1819.
4. 姚宏伟, 张忠涛, 郑民华. 直肠癌经肛全直肠系膜切除中国专家共识及临床实践指南 (2019 版). 中国实用外科杂志, 2019, 39(11): 1121-1128.
5. 中华人民共和国国家卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范 (2017 年版). 中国实用外科杂志, 2018, 38(10): 1089-1103.
6. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
7. Meyer R, Alcalay M, Jamal R, et al. Validation of the Wexner scale in a Hebrew-speaking population. Int Urogynecol J, 2020, 31(12): 2583-2587.
8. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
9. Keller DS, Berho M, Perez RO, et al. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol, 2020, 17(7): 414-429.
10. Gardner IH, Kelley KA, Abdelmoaty WF, et al. Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population. Surg Endosc, 2021 Jan 8, [Epub ahead of print].
11. Votava J, Kachlik D, Hoch J. Total mesorectal excision - 40 years of standard of rectal cancer surgery. Acta Chir Belg, 2020, 120(4): 286-290.
12. Dittrich L, Biebl M, Schmuck R, et al. Initial experience with the safe implementation of transanal total mesorectal excision (TaTME) as a standardized procedure for low rectal cancer. J Clin Med, 2020, 10(1): 72.
13. Shen Z, Yu G, Ren M, et al. Multicenter investigation of bowel evacuation function after transanal total mesorectal excision for mid-low rectal cancer. Int J Colorectal Dis, 2021, 36(4): 725-734.
14. Koedam TW, van Ramshorst GH, Deijen CL, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol, 2017, 21(1): 25-33.
15. 叶志伟, 陈远光, 胡明, 等. 直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究. 中国普通外科杂志, 2015, 24(4): 473-477.
16. Dulskas A, Smolskas E, Kildusiene I, et al. Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Colorectal Dis, 2018, 33(3): 251-260.
17. Nguyen TH, Chokshi RV. Low anterior resection syndrome. Curr Gastroenterol Rep, 2020, 22(10): 48.
18. 马全民, 申占龙, 刘凡, 等. 经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后肛门功能的比较. 中华结直肠疾病电子杂志, 2018, 7(4): 337-341.
19. Rubinkiewicz M, Zarzycki P, Witowski J, et al. Functional outcomes after resections for low rectal tumors: comparison of transanal with laparoscopic total mesorectal excision. BMC Surg, 2019, 19(1): 79.
20. Pontallier A, Denost Q, Van Geluwe B, et al. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc, 2016, 30(11): 4924-4933.
21. 佟伟华, 何亮, 张路遥, 等. 腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌患者术后排便功能评价及其影响因素分析. 中华消化外科杂志, 2019, 18(8): 761-767.
22. 窦若虚, 孙伟鹏, 罗双灵, 等. 经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后患者的肠道功能: 基于随机临床研究的比较. 中华胃肠外科杂志, 2019, 22(3): 246-254.
23. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 29-42.
24. Yang XH, Li KG, Wei JB, et al. Retrospective study of preoperative chemoradiotherapy with capecitabine versus capecitabine plus oxaliplatin for locally advanced rectal cancer. Sci Rep, 2020, 10(1): 12539.
25. Kasi A, Abbasi S, Handa S, et al. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer: A systematic review and meta-analysis. JAMA Netw Open, 2020, 3(12): e2030097.
26. Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer, 2015, 14(2): 106-114.
27. 袁凯涛, 马晋平. 直肠癌低位前切除术行预防性回肠末端造口是否影响直肠肛门功能—一项随访长达 12 年的随机多中心研究. 中华胃肠外科杂志, 2017, 20(9): 986.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of related factors affecting recovery of anal function after transanal total mesorectal excision

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