title: Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome.
abstract: BACKGROUND
  Transanal total mesorectal excision (TaTME) has rapidly become an important component of the treatment of rectal cancer surgery. Cohort studies have shown feasibility concerning procedure, specimen quality and morbidity. However, concerns exist about quality of life and ano(neo)rectal function. The aim of this study was to prospectively evaluate quality of life in patients following TaTME for rectal cancer with anastomosis.
  
  
  METHODS
  Consecutive patients who underwent restorative TaTME surgery for rectal adenocarcinoma in an academic teaching center with tertiary referral function were evaluated. Validated questionnaires were prospectively collected. Quality of life was assessed by the EuroQol 5D (EQ-5D), European Organization for Research and Treatment of Cancer's QLQ-C30 and QLQ-CR29 and low anterior resection syndrome (LARS) scale. Outcomes of the questionnaires at 1 and 6 months were compared with preoperative (baseline) values.
  
  
  RESULTS
  Thirty patients after restorative TaTME for rectal cancer were included. Deterioration for all domains was mainly observed at 1 month after surgery compared to baseline, but most outcomes had returned to baseline at 6 months. Social function and anal pain remained significantly worse at 6 months. Major LARS (score >30) was 33% at 6 months after ileostomy closure. No end colostomies were required.
  
  
  CONCLUSIONS
  TaTME is associated with acceptable quality of life and functional outcome at 6 months after surgery comparable to published results after conventional laparoscopic low anterior resection.
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. t.koedam@vumc.nl.
authors.forename: T W A
authors.initials: TW
authors.lastname: Koedam
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.|Department of Surgery, Antoni van Leeuwenhoek Hospital Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: G H
authors.initials: GH
authors.lastname: van Ramshorst
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Deijen
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: A K E
authors.initials: AK
authors.lastname: Elfrink
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: W J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Bonjer
authors.affiliation: Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Sietses
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Tuynman
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D000368:Aged; D000714:Anastomosis, Surgical; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D000067368:Transanal Endoscopic Surgery; D014555:Urination Disorders / Q000209:etiology
keywords: Cancer; PROMs; Quality of life; Rectum; Surgery; TaTME