INTRODUCTION: Over the last decades outcomes for rectal cancer surgery have improved, with increasing survival rates. Nevertheless, functional disorders are still frequent. AIM: To evaluate sexual and urinary outcomes of miniinvasive total mesorectal excision (TME). MATERIAL AND METHODS: Between March 2016 and June 2018 patients with rectal cancer who underwent miniinvasive TME with a sphincter-saving procedure were enrolled. The questionnaires were completed before therapy, and 6, 12, and 24 months after stoma closure. We used the Female Sexual Function Index (FSFI), the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function questionnaire (IIEF). RESULTS: Ninety-eight patients completed the questionnaires. Only patients who underwent laparoscopic (39) or robotic TME (27) were enrolled. The characteristics and surgical outcomes did not differ significantly between these groups. The IPSS between the groups was comparable before and after the operation with no significant difference, increased at 6 months and then decreased consecutively. In comparison with baseline, IPSS was significantly lower in the laparoscopic and robotic groups at 6 months and was comparable to baseline at 24 months in both groups. Oppositely, the IIEF was significantly lower at 6 months after ileostomy closure in the robotic group (p < 0.05), but not in the laparoscopic group (p = 0.59) and both returned to baseline at 24 months. FSFI was significantly lower in the laparoscopic group (p = 0.017) 6 months after surgery and returned to baseline at 24 months in both groups. CONCLUSIONS: Laparoscopic and robotic TME showed similar functional results 2 years after stoma resection.
- Publication type
- Journal Article MeSH
Úvod: Predná nízka resekcia s totálnou mezorektálnou excíziou (TME) u pacientov s karcinómom rekta zlepšila onkologické výsledky u tejto skupiny chorých. Avšak u veľkej skupiny nastávajú nemalé zmeny týkajúce sa kvality života a to vrátane rozličného stupňa črevnej dysfunkcie. Cieľom tejto štúdie je analyzovať prevalenciu LARS (low anterior resection syndrome, syndróm prednej nízkej resekcie) u pacientov s karcinómom rekta po restoratívnej miniinvazívnej resekcii a definovať jeho rizikové faktory. Metódy: Do štúdie boli zaradení pacienti, ktorí od 1. marca 2016 do 30. júna 2018 podstúpili elektívnu miniinvazívnu (laparoskopickú alebo robotickú) resekciu rekta. Na hodnotenie črevných výsledkov bol využitý LARS dotazník, vyplňovaný 6, 12 a 24 mesiacov od primárnej operácie a u pacientov s protektívnou deriváciou od resekcie ileostómie. 98 pacientov vyplnilo kompletne dotazníky. Z toho 58 výkonov bolo laparoskopických, 34 robotických a 6 otvorených. 69 pacientov podstúpilo TME, tumor-špecifickú mezorektálnu excíziu podstúpilo 21 pacientov. U 8 pacientov bola vykonaná transanálna TME. Skupiny sa nelíšili v charakteristike sledovaných vstupných parametroch. Neoadjuvantnú liečbu však podstúpilo signifikantne viac pacientov v robotickej skupine (p=0,004). Výsledky: 59,8 % pacientov malo závažný LARS 6 mesiacov od operačného výkonu. O 24 mesiacov, podiel pacientov klesol na 29,7% . Potencionálne rizikové faktory ťažkého LARS v našom súbore sú vek (p<0,05), vzdialenosť tumoru (p<0,001), dĺžka času resekcie ileostómie od primárnej operácie (p<0,05), neoadjuvatná (p<0,001) a adjuvantná liečba (p<0,05). Záver: Prevalencia ťažkého LARS syndrómu je vysoká. Predstavuje závažný, často skrytý a opomínaný problém. Rádioterapia a TME sú významné rizikové faktory závažného LARS.
Introduction: Over the last decades outcomes for rectal cancer surgery have improved with increasing survival and lower recurrence rates. Nevertheless, functional disorders are still frequent. Low anterior resection with total mesorectal excision (TME) in patients with rectal cancer has improved oncological outcomes. However, most of them will have significant changes in quality of life, including varying degree of bowel dysfunction. Aim of this study was to analyse prevalence of LARS (low anterior resection syndrome) in patients with rectal cancer after miniinvasive restorative resection and to define its risk factors. Methods: Between March 2016 and June 2018, patients who underwent elective miniinvasive (laparoscopic or robotic) rectal resection were enrolled. Bowel dysfunction was evaluated by LARS questionnaire and filled out 6, 12, and 24 months after primary operation or after ileostomy closure. 98 patients completed the questionnaires – 58 laparoscopic operations, 34 robotic and 6 open procedures. 69 patients underwent TME, tumor-specific mesorectal excision 21 patients. 8 patients underwent transanal TME. The clinical characteristics, surgical perioperative and postoperative outcomes did not differ between these groups. Only, significantly more patients underwent neoadjuvant radiotherapy in the robotic group (p=0.004). Results: 59.8% patients reported major LARS 6 months after surgery and 29.7% after 24 months. Protentional risk factors are age (p<0.05), tumor height (p<0.001), time from stoma resection (p<0.05), neoadjuvant (p<0.001) and adjuvant therapy (p<0.05). Conclusion: Prevalence of LARS is high. It is underestimated, although an important factor. Radiotherapy and TME are significant risk factors of major LARS.
