Quality of Life impairment after Endoluminal Loco-Regional Resection (ELRR) and Laparoscopic Total Mesorectal Excision (LTME).

Emanuele Lezoche, MD, Bernardina Fabiani, MD, Alessandro M. Paganini, MD, PhD, Andrea Balla, MD, Annarita Vestri, MD, Lorenzo Pescatori, MD, Daniele Scoglio, MD, Giancarlo D’Ambrosio, MD, Giovanni Lezoche, MD

Department of Surgery ‘P. Stefanini’, Policlinico Umberto I, ‘Sapienza’ University of Rome

Introduction: In selected patients with rectal cancer Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) is an alternative treatment option instead of Laparoscopic Total Mesorectal Excision (LTME). Quality of life (QoL) data after laparoscopic TME are controversial and few studies have reported QoL evaluation after TEM. Aim is to compare the short and medium term QoL in T1 rectal cancer patients undergoing LTME or ELRR.

Methods and Procedures: Prospectively collected data from 36 patients with T1, N0 rectal cancer undergoing TEM (n=17) or LTME (n= 18) were compared. QoL was evaluated using EORTC QLQ-C30 and QLQ-C38 questionnaires, that patients completed preoperatively and at 1, 6 and 12 months after surgery.

Results: One month after LTME, statistically significant worsening was observed in all items of both questionnaires; worsening did not reach significance, as compared to preoperative status, only in global health status (p= 0.205). One month after TEM a statistically significant difference was observed in gastrointestinal (p=0.005) and defecation problems (p=0.001) by QLQ-CR38, and in global health status (p=0.014), in physical (p=0.02) and role functioning (p=0.003), in fatigue (p=0.002) and in pain (p=0.001) by QLQ-C30. Six months after LTME there was a statistically significant worsening in body image (p= 0.009), micturition (p= 0.035) and gastrointestinal (p= 0.011) problems by QLQ-CR38 and physical (p= 0.003) and role functioning (p= 0.002), fatigue (p= 0.004) and nausea/vomiting (p= 0.030) by QLQ-C30. Six months after TEM both QLQ-CR38 and QLQ-C30 questionnaires showed no statistical significance. However, global health status and physical functioning improved. Twelve months after LTME there was significant improvement in defecation problems (p= 0.004) and weight loss (p= 0.003) in QLQ-CR38 and in global health status (p= 0.001), nausea/vomiting (p= 0.003) and pain (p= 0.005) in QLQ-C30. Twelve months after TEM a significant improvement was observed in emotional functioning (p= 0.012) in QLQ-C30. No significant difference was observed in QLQ-C38.

Conclusions: Functional sequelae and postoperative symptoms are present up to one month after TEM and up to six months after LTME. However, no significant worsening in quality of life was observed 12 months after both procedures. Based on the present study, in selected patients with T1,N0 rectal cancer functional outcomes and QoL are improved six months after TEM, as compared to LTME.

Session: Podium Presentation

Program Number: S056

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