title: Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision.
abstract: BACKGROUND
  For selected patients with rectal cancer, endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Few data are available on quality of life (QoL) after LTME and TEM. This study aimed to compare short- and medium-term QoL for T1 rectal cancer patients undergoing LTME or ELRR by TEM.
  
  
  METHODS
  This study investigated 35 patients with T1N0 rectal cancer who underwent TEM (n = 17) or LTME (n = 18). Quality of life was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C38 questionnaires preoperatively and then 1, 6, and 12 months after surgery.
  
  
  RESULTS
  Observation 1 month after LTME showed worsening in all items of both questionnaires. After ELRR, the QLQ-CR38 showed worsening of gastrointestinal (p = 0.005) and defecation problems (p = 0.001), and the QLQ-C30 showed worsening of global health status (p = 0.014), physical functioning (p = 0.02) role functioning (p = 0.003), fatigue (p = 0.002), and pain (p = 0.001). The QLQ-CR38 6 months after LTME showed worsening of body image (p = 0.009), micturition (p = 0.035), and gastrointestinal problems (p = 0.011), and the QLQ-C30 showed worsening of physical functioning (p = 0.003), role functioning (p = 0.002), fatigue (p = 0.004), and nausea/vomiting (p = 0.030). After ELRR, neither the QLQ-CR38 nor the QLQ-C30 questionnaire showed any worsening but demonstrated improvement in global health status and physical functioning. The QLQ-CR38 12 months after LTME showed significant improvement in defecation problems (p = 0.004) and weight loss (p = 0.003), and the QLQ-C30 showed significant improvement in global health status (p = 0.001), nausea and vomiting (p = 0.003), and pain (p = 0.005). After ELRR, the QLQ-C30 showed improvement in emotional functioning (p = 0.012), whereas no significant difference was observed by the QLQ-C38.
  
  
  CONCLUSIONS
  Functional sequelae are present up to 1 month only after ELRR by TEM and up to 6 months after LTME. At 12 months, neither procedure showed a significant difference in QoL compared with preoperative status.
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
authors.forename: Bernardina
authors.initials: B
authors.lastname: Fabiani
authors.forename: Andrea
authors.initials: A
authors.lastname: Balla
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pescatori
authors.forename: Daniele
authors.initials: D
authors.lastname: Scoglio
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lezoche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006304:Health Status; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D012002:Rectal Diseases / Q000209:etiology / Q000523:psychology*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires