title: Long-term functional results and quality of life after transanal endoscopic microsurgery.
abstract: BACKGROUND
  Of the few studies that have investigated quality-of-life (QoL) outcomes after transanal endoscopic microsurgery (TEM), the majority have reported only short-term follow-up data. This study assessed long-term clinical and instrumental outcomes (QoL, sexual, urinary and sphincter function) after TEM for extraperitoneal rectal cancer.
  
  
  METHODS
  Preoperative and postoperative anorectal function was assessed in consecutive patients with benign rectal lesions or early rectal cancer, based on clinical scores and anorectal manometry.
  
  
  RESULTS
  Between January 2000 and July 2005, 93 patients undergoing TEM completed the 60-month study protocol. The mean Wexner continence score increased from baseline at 3 months, began to decline within 12 months, and had returned to the preoperative value at 60 months. Urgency was reported by 65·0, 30·0 and 5 per cent of patients at 3, 12 and 60 months respectively (P < 0·050). A significant improvement was noted in various clinical and QoL scores at 12 and 60 months. Postoperative manometry values at 3 months were significantly lower than at baseline (P < 0·050), but had returned to preoperative values at 12 months. Tumour size of 4 cm or above was the only factor that significantly (P = 0·008) affected the rectal sensitivity threshold, the urge to defaecate threshold and the maximum tolerated volume at 3 months after TEM.
  
  
  CONCLUSIONS
  TEM had no long-term effect on anorectal function or QoL. Lower anal resting pressure at early follow-up was not associated with defaecation problems in patients who were continent before surgery.
authors.affiliation: Department of Digestive Surgery and Centre for Minimally Invasive Surgery, University of Turin, 14 Corso Achille Mario Dogliotti, 10126 Turin, Italy.
authors.forename: M E
authors.initials: ME
authors.lastname: Allaix
authors.forename: F
authors.initials: F
authors.lastname: Rebecchi
authors.forename: C
authors.initials: C
authors.lastname: Giaccone
authors.forename: M
authors.initials: M
authors.lastname: Mistrangelo
authors.forename: M
authors.initials: M
authors.lastname: Morino
mesh_terms: D000230:Adenocarcinoma / Q000503:physiopathology / Q000601:surgery*; D000236:Adenoma / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011312:Pressure; D011351:Proctoscopy / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*