Skip to main content
SpringerLink
Log in

Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The introduction of transanal endoscopic or minimally invasive surgery has allowed organ preservation for rectal tumors with good oncological results. Data on functional and quality-of-life (QoL) outcomes are scarce and controversial. This systematic review sought to synthesize fecal continence, QoL, and manometric outcomes after transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS).

Methods

A systematic review of the literature including Medline, Embase, and the Cochrane Library databases was conducted searching for articles reporting on functional outcomes after TEM or TAMIS between January 1995 and June 2018. The evaluated outcome parameters were pre- and postoperative fecal continence (primary endpoint), QoL, and manometric results. Data were extracted using the same scales and measurement units as from the original study.

Results

A total of 29 studies comprising 1297 patients were included. Fecal continence outcomes were evaluated in 23 (79%) studies with a wide variety of assessment tools and divergent results. Ten studies (34%) analyzed QoL changes, and manometric variables were assessed in 15 studies (51%). Most studies reported some deterioration in manometric scores without major QoL impairment. Due to the heterogeneity of the data, it was not possible to perform any pooled analysis or meta-analysis.

Conclusions

These techniques do not seem to affect continence by themselves except in minor cases. The possibility of worsened function after TEM and TAMIS should not be underestimated. There is a need to homogenize or standardize functional and manometric outcomes assessment after TEM or TAMIS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peeters KCMJ, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol Off J Am Soc Clin Oncol 23:6199–6206. https://doi.org/10.1200/JCO.2005.14.779

    Article  CAS  Google Scholar 

  2. Dahlberg M, Glimelius B, Graf W, Påhlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41:543–549 discussion 549-551

    Article  CAS  Google Scholar 

  3. Pollack J, Holm T, Cedermark B et al (2006) Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 49:345–352. https://doi.org/10.1007/s10350-005-0296-1

    Article  PubMed  Google Scholar 

  4. Nesbakken A, Nygaard K, Bull-Njaa T et al (2000) Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 87:206–210. https://doi.org/10.1046/j.1365-2168.2000.01357.x

    Article  CAS  PubMed  Google Scholar 

  5. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502

    CAS  PubMed  Google Scholar 

  6. Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum - testing a new method in animal experiments. Leber Magen Darm 13:73–77

    CAS  PubMed  Google Scholar 

  7. Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205. https://doi.org/10.1007/s00464-010-0927-z

    Article  PubMed  Google Scholar 

  8. Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1030; discussion 1030-1031. https://doi.org/10.1007/s10350-008-9337-x

    Article  PubMed  Google Scholar 

  9. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 56:301–307. https://doi.org/10.1097/DCR.0b013e31827ca313

    Article  PubMed  Google Scholar 

  10. deBeche-Adams T, Nassif G (2015) Transanal minimally invasive surgery. Clin Colon Rectal Surg 28:176–180. https://doi.org/10.1055/s-0035-1555008

    Article  PubMed  PubMed Central  Google Scholar 

  11. Serra-Aracil X, Pericay C, Golda T, Mora L, Targarona E, Delgado S, Reina A, Vallribera F, Enriquez-Navascues JM, Serra-Pla S, Garcia-Pacheco JC, TAU-TEM study group (2018) Non-inferiority multicenter prospective randomized controlled study of rectal cancer T2-T3s (superficial) N0, M0 undergoing neoadjuvant treatment and local excision (TEM) vs total mesorectal excision (TME). Int J Color Dis 33:241–249. https://doi.org/10.1007/s00384-017-2942-1

    Article  CAS  Google Scholar 

  12. Pellino G, Warusavitarne J (2017) Medium-term adoption trends for laparoscopic, robotic and transanal total mesorectal excision (TaTME) techniques. Tech Coloproctol 21:911–913. https://doi.org/10.1007/s10151-017-1719-4

    Article  CAS  PubMed  Google Scholar 

  13. Cataldo PA, O’Brien S, Osler T (2005) Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 48:1366–1371. https://doi.org/10.1007/s10350-005-0031-y

    Article  PubMed  Google Scholar 

  14. Wang H-S, Lin J-K, Yang S-H, Jiang JK, Chen WS, Lin TC (2003) Prospective study of the functional results of transanal endoscopic microsurgery. Hepatogastroenterology 50:1376–1380

    PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

    Article  Google Scholar 

  16. Deeks JJ, Dinnes J, D’Amico R et al (2003) Evaluating non-randomised intervention studies. Health Technol Assess Winch Engl 7:iii–iix 1–173

    CAS  Google Scholar 

  17. Kennedy ML, Lubowski DZ, King DW (2002) Transanal endoscopic microsurgery excision: is anorectal function compromised? Dis Colon Rectum 45:601–604

    Article  CAS  Google Scholar 

  18. Mora López L, Serra Aracil X, Hermoso Bosch J et al (2015) Study of anorectal function after transanal endoscopic surgery. Int J Surg Lond Engl 13:142–147. https://doi.org/10.1016/j.ijsu.2014.11.021

    Article  Google Scholar 

  19. Jin Z, Yin L, Xue L, Lin M, Zheng Q (2010) Anorectal functional results after transanal endoscopic microsurgery in benign and early malignant tumors. World J Surg 34:1128–1132. https://doi.org/10.1007/s00268-010-0475-7

    Article  PubMed  Google Scholar 

  20. Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643. https://doi.org/10.1002/bjs.7584

    Article  CAS  PubMed  Google Scholar 

  21. Barendse RM, Oors JM, de Graaf EJR et al (2013) The effect of endoscopic mucosal resection and transanal endoscopic microsurgery on anorectal function. Color Dis 15:e534–e541. https://doi.org/10.1111/codi.12311

    Article  CAS  Google Scholar 

  22. Khoury W, Gilshtein H, Nordkin D, Kluger Y, Duek SD (2013) Repeated transanal endoscopic microsurgery is feasible and safe. J Laparoendosc Adv Surg Tech A 23:216–219. https://doi.org/10.1089/lap.2012.0394

    Article  PubMed  Google Scholar 

  23. Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Color Dis 16:370–376

    Article  CAS  Google Scholar 

  24. Ghiselli R, Ortenzi M, Cardinali L, Skrami E, Gesuita R, Guerrieri M (2017) Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy. Surg Endosc 31:2997–3003. https://doi.org/10.1007/s00464-016-5321-z

    Article  PubMed  Google Scholar 

  25. Biviano I, Balla A, Badiali D et al (2017) Anal function after endoluminal locoregional resection by transanal endoscopic microsurgery and radiotherapy for rectal cancer. Color Dis 19:O177–O185. https://doi.org/10.1111/codi.13656

    Article  CAS  Google Scholar 

  26. Hompes R, Ashraf SQ, Gosselink MP et al (2015) Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Color Dis 17:O54–O61. https://doi.org/10.1111/codi.12858

    Article  CAS  Google Scholar 

  27. Doornebosch PG, Gosselink MP, Neijenhuis PA, Schouten WR, Tollenaar RA, de Graaf EJ (2008) Impact of transanal endoscopic microsurgery on functional outcome and quality of life. Int J Color Dis 23:709–713. https://doi.org/10.1007/s00384-008-0442-z

    Article  CAS  Google Scholar 

  28. Planting A, Phang PT, Raval MJ, Brown CJ (2013) Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life. Can J Surg J Can Chir 56:243–248. https://doi.org/10.1503/cjs.028411

    Article  Google Scholar 

  29. Wałęga P, Kenig J, Richter P (2014) Transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection in the treatment of patients with T1 rectal cancer - 3-year results. Wideochirurgia Inne Tech Maloinwazyjne Videosurgery Miniinvasive Tech 9:40–45. https://doi.org/10.5114/wiitm.2014.40384

    Article  Google Scholar 

  30. Kreis ME, Jehle EC, Haug V, Manncke K, Buess GF, Becker HD, Starlinger MJ (1996) Functional results after transanal endoscopic microsurgery. Dis Colon Rectum 39:1116–1121

    Article  CAS  Google Scholar 

  31. Meng WCS, Lau PYY, Yip AWC (2004) Treatment of early rectal tumours by transanal endoscopic microsurgery in Hong Kong: prospective study. Hong Kong Med J Xianggang Yi Xue Za Zhi 10:239–243

    CAS  PubMed  Google Scholar 

  32. Gracia Solanas JA, Ramírez Rodríguez JM, Aguilella Diago V et al (2006) A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig 98:234–240

    CAS  Google Scholar 

  33. Karakayali FY, Tezcaner T, Moray G (2015) Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors. J Minimal Access Surg 11:257–262. https://doi.org/10.4103/0972-9941.152094

    Article  Google Scholar 

  34. García-Flórez LJ, Otero-Díez JL, Encinas-Muñiz AI, Sánchez-Domínguez L (2017) Indications and outcomes from 32 consecutive patients for the treatment of rectal lesions by transanal minimally invasive surgery. Surg Innov 24:336–342. https://doi.org/10.1177/1553350617700803

    Article  PubMed  Google Scholar 

  35. Schiphorst AHW, Langenhoff BS, Maring J, Pronk A, Zimmerman DD (2014) Transanal minimally invasive surgery: initial experience and short-term functional results. Dis Colon Rectum 57:927–932. https://doi.org/10.1097/DCR.0000000000000170

    Article  PubMed  Google Scholar 

  36. Verseveld M, Barendse RM, Gosselink MP et al (2016) Transanal minimally invasive surgery: impact on quality of life and functional outcome. Surg Endosc 30:1184–1187. https://doi.org/10.1007/s00464-015-4326-3

    Article  PubMed  Google Scholar 

  37. Clermonts SHEM, van Loon YT, Schiphorst AHW, Wasowicz DK, Zimmerman DDE (2017) Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results. Int J Color Dis 32:1677–1685. https://doi.org/10.1007/s00384-017-2893-6

    Article  CAS  Google Scholar 

  38. Lezoche E, Paganini AM, Fabiani B, Balla A, Vestri A, Pescatori L, Scoglio D, D'Ambrosio G, Lezoche G (2014) Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision. Surg Endosc 28:227–234. https://doi.org/10.1007/s00464-013-3166-2

    Article  PubMed  Google Scholar 

  39. D’Ambrosio G, Balla A, Mattei F et al (2015) Quality of life after endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM). Ann Ital Chir 86:56–60

    PubMed  Google Scholar 

  40. Arezzo A, Arolfo S, Allaix ME et al (2015) Results of neoadjuvant short-course radiation therapy followed by transanal endoscopic microsurgery for t1-t2 n0 extraperitoneal rectal cancer. Int J Radiat Oncol Biol Phys 92:299–306. https://doi.org/10.1016/j.ijrobp.2015.01.024

    Article  PubMed  Google Scholar 

  41. Hemingway D, Flett M, McKee F, Finlay IG (1996) Sphincter function after transanal endoscopic microsurgical excision of rectal tumours. British Journal of Surgery 83: 51–52

    Article  CAS  Google Scholar 

  42. Banerjee AK, Jehle EC, Kreis ME et al (1996) Prospective study of the proctographic and functional consequences of transanal endoscopic microsurgery. Br J Surg 83:211–213

    Article  CAS  Google Scholar 

  43. Léonard D, Colin J-F, Remue C, Jamart J, Kartheuser A (2012) Transanal endoscopic microsurgery: long-term experience, indication expansion, and technical improvements. Surg Endosc 26:312–322. https://doi.org/10.1007/s00464-011-1869-9

    Article  PubMed  Google Scholar 

  44. Da Silva GM, Berho M, Wexner SD et al (2003) Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 46:1492–1497. https://doi.org/10.1097/01.DCR.0000093642.89267.67

    Article  PubMed  Google Scholar 

  45. Yarnold J, Brotons M-CV (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol J Eur Soc Ther Radiol Oncol 97:149–161. https://doi.org/10.1016/j.radonc.2010.09.002

    Article  CAS  Google Scholar 

  46. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Dimelza Osorio Sánchez for her assistance during the search process.

Author information

Authors and Affiliations

  1. Colorectal Unit – Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Franco G. Marinello, Anna Curell, Ingrid Tapiolas, Gianluca Pellino, Francesc Vallribera & Eloy Espin

  2. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy

    Gianluca Pellino

Authors
  1. Franco G. Marinello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Curell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ingrid Tapiolas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianluca Pellino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesc Vallribera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eloy Espin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franco G. Marinello.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

figure a
figure b
figure c
Table 5 Study characteristics by Newcastle-Ottawa quality assessment scale score
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marinello, F.G., Curell, A., Tapiolas, I. et al. Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution. Int J Colorectal Dis 35, 51–67 (2020). https://doi.org/10.1007/s00384-019-03439-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03439-3

Keywords

Search

Navigation