title: Transanal minimally invasive surgery: impact on quality of life and functional outcome.
abstract: BACKGROUND
  Transanal minimally invasive surgery (TAMIS) is emerging as an alternative to transanal endoscopic microsurgery. Quality of life (QOL) and functional outcome are important aspects when valuing a new technique. The aim of this prospective study was to assess both functional outcome and QOL after TAMIS.
  
  
  METHODS
  From 2011 to 2013, patients were prospectively studied prior to and at least 6 months after TAMIS for rectal adenomas and low-risk T1 carcinomas using a single-site laparoscopy port. Functional outcome was determined using the Faecal Incontinence Severity Index (FISI). Quality of life was measured using functional [Faecal Incontinence Quality of Life (FIQL)] and generic (EuroQol EQ-5D) questionnaires.
  
  
  RESULTS
  The study population consisted of 24 patients 13 men, median age 59 (range 42-83) with 24 tumours [median distance from the dentate line 8 cm (range 2-17 cm); median tumour size 6 cm(2) (range 0.25-51 cm(2)); 20 adenomas; 4 low-risk T1 carcinomas]. Post-operative complications occurred in one patient (4 %; grade IIIb according to Clavien Dindo classification). Compared to baseline, FISI remained unaffected (9.8 vs 7.3; P = 0.26), FIQL remained unaffected, and EuroQol EQ-5D improved (EQ-VAS: 77 vs 83; P = 0.04).
  
  
  CONCLUSIONS
  There was no detrimental effect of TAMIS on anorectal function. Overall QOL was improved after TAMIS, probably due to removal of the tumour, and at 6 months was equal to the general population.
authors.affiliation: Department of General Surgery, IJsselland Hospital, P.O. Box 960, Capelle aan den Ijssel, The Netherlands. m.verseveld@erasmusmc.nl.|Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. m.verseveld@erasmusmc.nl.
authors.forename: Maria
authors.initials: M
authors.lastname: Verseveld
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Renée M
authors.initials: RM
authors.lastname: Barendse
authors.affiliation: Department of Surgery, Oxford University Hospital, Oxford, UK.
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Gosselink
authors.affiliation: Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of General Surgery, IJsselland Hospital, P.O. Box 960, Capelle aan den Ijssel, The Netherlands.
authors.forename: Eelco J R
authors.initials: EJ
authors.lastname: de Graaf
authors.affiliation: Department of General Surgery, IJsselland Hospital, P.O. Box 960, Capelle aan den Ijssel, The Netherlands.
authors.forename: Pascal G
authors.initials: PG
authors.lastname: Doornebosch
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*
keywords: Anorectal function; Faecal incontinence; Quality of life; Transanal endoscopic microsurgery; Transanal minimally invasive surgery