Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer.
BACKGROUND
Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant.


OBJECTIVE
The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy.


METHODS
This is a cross-sectional study.


METHODS
The study was conducted at a tertiary referral colorectal center.


METHODS
Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life.


METHODS
Quality of life, functional outcomes, and patient satisfaction were measured and compared by age, tumor level, and stage of the disease.


RESULTS
A total of 133 surveys were mailed, and 90 patients responded and were included in the study. Patient quality of life was not significantly different after surgery. Patients with more proximal tumors had better lifestyle, physical, and emotional scores. Older patients performed better on multiple levels, including coping, emotional, body image, future perspective, and digestive. Stage of disease had no impact on quality of life. Compared with reference values, patients who underwent transanal abdominal transanal proctectomy performed better on most of the components. All of patients preferred transanal abdominal transanal proctectomy over having a stoma based on their current anal sphincter function, and >97% of patients preferred transanal abdominal transanal proctectomy based on their current quality of life, sexual function, and level of activities.


CONCLUSIONS
This study is limited by the lack of a comparison group and a potential selection bias.


CONCLUSIONS
Satisfaction with quality of life and functional outcomes is high after transanal abdominal transanal proctectomy. Older patients and those with more proximal tumors performed better. This patient population clearly preferred a sphincter-preserving option for treatment of their rectal cancer.
1 Division of Colorectal Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 2 Department of Surgery, University of Iceland, Reykjavik, Iceland.
John H
JH
Marks
Jean F
JF
Salem
Elsa B
EB
Valsdottir
Shadi S
SS
Yarandi
Gerald J
GJ
Marks
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D039021:Colonic Pouches; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology; D011351:Proctoscopy / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012004:Rectal Neoplasms / Q000523:psychology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires