Impact of transanal endoscopic microsurgery on functional outcome and quality of life.
BACKGROUND
Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for local excision of rectal tumours. The procedure is performed via a rectoscope with a diametre of 4 cm. The aim of this prospective study was to assess both functional outcome and quality of life after TEM.


METHODS
Between 2004 and 2006, 47 patients were studied prior to and at least 6 months after TEM. Demographics, operative details and post-operative complications were recorded. Functional outcome was determined using the Faecal Incontinence Severity Index (FISI). Quality of life was measured using the EuroQol EQ-5D questionnaire and the Faecal Incontinence Quality of Life (FIQL) score.


RESULTS
Six months after surgery, median FISI score was found to be decreased (p<0.01), depicting an improvement in faecal continence. This improvement was most significant in tumours within 7 cm from the dentate line (p=0.01). From the patients' perspective, post-operative quality of life was found to be higher (p<0.02). A significant improvement was observed in two of the four FIQLS domains (embarrassment, p=0.03; lifestyle, p=0.05). The domains of lifestyle, coping and behaviour and embarrassment were correlated with the FISI (all p<0.05).


CONCLUSIONS
This study indicates TEM has no deteriorating effect on faecal continence. Moreover, once the tumour has been excised using TEM, quality of life is improved.
Doornebosch
P G
PG
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. pgdoornebosch@hotmail.com
Gosselink
M P
MP
Neijenhuis
P A
PA
Schouten
W R
WR
Tollenaar
R A E M
RA
de Graaf
E J R
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome