Low anterior resection syndrome after transanal total mesorectal excision: a comparison with the conventional top to bottom approach

Abstract

BACKGROUND: Advances in sphincter saving procedures improved the quality of life of patients with rectal cancer. However, many of them suffered from functional disturbance after surgery, including the low anterior resection syndrome.

OBJECTIVE: The aim of this study was to evaluate the severity of low anterior resection syndrome after transanal total mesorectal excision and compare with the conventional transabdominal, top to bottom, total mesorectal excision.

SETTINGS: The study was conducted at a tertiary academic institution.

DESIGN AND PATIENTS: This was a single-center, retrospective analysis of patients who underwent total mesorectal excision for mid to low rectal cancer from January 2016 to April 2018. Cases were matched one-to-one according to the tumor height and history of pelvic irradiation using propensity score.

MAIN OUTCOME MEASURES: The severity of low anterior resection syndrome and fecal incontinence at 3, 6, and 12 months after surgery or stoma reversal, whichever was later.

RESULTS: There were 35 patients in each group after matching. 67.1% were male. 41.4% had neoadjuvant radiotherapy. At three months, the median low anterior resection syndrome score was 37 after transanal total mesorectal excision, which was significantly higher than the conventional approach, 32 (p=0.045). Apart from this, the low anterior resection syndrome score, severity grading and the Wexner score were comparable at 6 and 12 months.

LIMITATIONS: A difference between the two groups might not be detected due to the study’s small sample size. The retrospective nature of the study.

CONCLUSIONS: A higher low anterior resection syndrome score was observed after transanal total mesorectal excision at the initial three months period but such difference was not observed thereafter. This study showed that both surgical techniques had similar anal and bowel functional outcomes in the long run. However, due to the limited case number and study design, further study is needed to prove this. See Video Abstract at http://links.lww.com/DCR/B146.