title: Quality of life in non-early rectal cancer treated by neoadjuvant radio-chemotherapy and endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) versus laparoscopic total mesorectal excision.
abstract: BACKGROUND
  In selected patients with N0 rectal cancer, endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Aim of this study is to evaluate the short- and medium-term quality of life (QoL) from a retrospective analysis of prospectively collected data in patients with iT2-iT3 N0-N+ rectal cancer, who underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT).
  
  
  METHODS
  Thirty patients with iT2-iT3 rectal cancer who underwent ELRR by TEM (n = 15) or LTME (n = 15) were enrolled in this study. The choice for one operation or the other was made on the basis of predefined criteria. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission, after n-RCT and 1, 6, and 12 months after surgery.
  
  
  RESULTS
  No statistically significant differences in QoL evaluation were observed between the two groups, both at admission and after n-RCT. At 1 month after surgery, significantly better results in the ELRR group were observed by QLQ-C30 in: Nausea/Vomiting (p = 0.05), Appetite Loss (p = 0.003), Constipation (p = 0.05), and by QLQ-CR38 in: Body Image (p = 0.05), Sexual Functioning (p = 0.03), Future Perspective (p = 0.05) and Weight Loss (p = 0.036). At 6 months after surgery, a statistically significant worse impact after LTME was observed by QLQ-C30 in: Global Health Status (p = 0.05), Emotional Functioning (p = 0.021), Dyspnea (p = 0.008), Insomnia (p = 0.012), Appetite Loss (p = 0.014) and by QLQ-CR38 in Body Image (p = 0.05) and Defecation Problems (p = 0.001). At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the QLQ-CR38 still showed better results of ELRR versus LTME in Body Image (p = 0.006), Defecation Problems (p = 0.01), and Weight Loss (p = 0.005).
  
  
  CONCLUSIONS
  Based on the present series, in selected patients, earlier restoration of patients' functions is observed after ELRR by TEM than after LTME.
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy. giancarlodambrosio@libero.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy. andrea.balla@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Balla
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Quaresima
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ursi
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzone
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchetto
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Fabrizio I
authors.initials: FI
authors.lastname: Mattei
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D000067369:Transanal Endoscopic Microsurgery; D016896:Treatment Outcome
keywords: Endoluminal loco-regional resection (ELRR); Laparoscopic total mesorectal excision (LTME); Neoadjuvant radio-chemotherapy (n-RCT); Quality of life (QoL); Rectal cancer; Transanal endoscopic microsurgery (TEM)