title: Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy.
abstract: In patients who exhibit a complete clinical response after radio-chemotherapy for rectal cancer, the standard surgical approach might constitute overtreatment. The aim of this study is to analyse the outcomes of anorectal function and quality of life after transanal endoscopic microsurgery (TEM) in irradiated patients with complete clinical response.
  
  
  
  Between 2007 and 2014, 84 patients who were diagnosed with stage T2-T3-T4 N0 rectal cancer before chemoradiotherapy showed a complete clinical response to neoadjuvant therapy and underwent TEM. All patients were evaluated before and 1 year after TEM using the Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) questionnaire to determine the impact of this surgical technique on the degree of faecal continence. To assess the quality of life of patients after surgery, we administered the Fecal Incontinence Quality of Life Scale.
  
  
  
  Twenty-three patients exhibited a worse incontinence status after surgical intervention (27.4; 95% CI 18.2-38.2). These patients experienced a median positive absolute variation in the CCF-FIS of four points (95% CI 3.5-4.5; p < 0.001). Female sex and age showed a significant correlation with the worsening of continence status. Scores on the Fecal Incontinence Quality of Life Index Scale did not show a significant difference before and after TEM.
  
  
  
  TEM may be an alternative treatment for patients with rectal cancer who exhibit a complete clinical response to neoadjuvant chemoradiotherapy because it offers the possibility to achieve a full thickness excision of the rectal wall. TEM also allows the identification of any residual disease and provides optimal quality of life and functional results.
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, 60126, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ghiselli
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, 60126, Ancona, Italy. monica.ortenzi@gmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Ortenzi
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, 60126, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cardinali
authors.affiliation: Interdepartmental "Epidemilogia, Biostatistica e Informatica Medica (EBI)" Centre, Università Politecnica delle Marche, 60126, Ancona, Italy.
authors.forename: Edlira
authors.initials: E
authors.lastname: Skrami
authors.affiliation: Interdepartmental "Epidemilogia, Biostatistica e Informatica Medica (EBI)" Centre, Università Politecnica delle Marche, 60126, Ancona, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, 60126, Ancona, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Guerrieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology* / Q000601:surgery / Q000628:therapy; D011795:Surveys and Questionnaires; D000067369:Transanal Endoscopic Microsurgery / Q000379:methods*
keywords: Anorectal function; Neoadjuvant radiotherapy; Rectal cancer; Transanal endoscopic microsurgery