title: Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life.
abstract: BACKGROUND
  Anal dilation during tumour excision with transanal endoscopic microsurgery (TEM) has caused concerns regarding postoperative anal function. We sought to determine whether TEM affects anorectal function and quality of life.
  
  
  METHODS
  All patients undergoing TEM between March 2007 and December 2008 were considered for inclusion. We excluded patients who were treated with subsequent radical resection, unavailable for interview or deceased. Patients were interviewed by phone to measure the preoperative and postoperative function using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core 30 (EORTC QLQ-C30) and Core 38 (CR38) instruments, the Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life (FIQL) questionnaires. Statistical analysis involved the Wilcoxon signed rank test and Spearman rank correlation coefficient.
  
  
  RESULTS
  Forty patients received TEM; 30 of them met all inclusion criteria and agreed to participate. The median age was 70 (42-93) years, and median follow-up time between the interview and the operation was 365 (55-712) days. Tumours excised included 19 adenomas, 8 carcinomas and 3 carcinoid tumours. The median distance from the tumour to the anal verge was 6.5 (2-13) cm. Median length of stay was 1 (0-12) day. For most aspects of quality of life, there were no detectable differences after surgery. The EORTC QLQ-C30 showed a significant improvement in diarrhea (27.8 v. 10, p = 0.002). The FIQL scores improved with surgery (3.59 v. 3.85, p = 0.020). There was no difference in pre- versus postoperative FISI scores (6.7 v. 6.3, p = 0.93).
  
  
  CONCLUSIONS
  Despite a large operating rectoscope, TEM improves quality of life related to fecal incontinence and does not have a negative impact on fecal continence.
authors.affiliation: Department of Surgery, St Paul's Hospital, Vancouver and the University of British Columbia, Vancouver, BC.
authors.forename: Anneke
authors.initials: A
authors.lastname: Planting
authors.forename: P Terry
authors.initials: PT
authors.lastname: Phang
authors.forename: Manoj J
authors.initials: MJ
authors.lastname: Raval
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Brown
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D018253:Adenoma, Villous / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D005242:Fecal Incontinence / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires