Quality of Life in Rectal Cancer Treated by Endoluminal Loco-Regional Resection by Tem Vs Laparoscopic Total Mesorectal Excision: Long Term Results

Background: Endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME), in selected patients with N0 rectal cancer. Post-operative Quality of Life (QoL) evaluation is an important parameter of outcomes related to high percentage of functional sequelae. We reported, in a previous published paper, the short and medium term results of QoL in patients underwent ELRR by TEM or LTME. Aim: The aim is to evaluate the 3y QoL in patients with iT2-T3 N0/ + rectal cancer underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT) in a retrospective analysis of prospectively collected data. Materials and Methods: We enrolled in this study 39 patients with iT2–iT3 rectal cancer who underwent ELRR by TEM (n=19) or LTME (n=20), according to predefined criteria. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission, after n-RCT and 1, 6, 12 and 36 months after surgery. Results: No statistically significant differences in QoL evaluation were observed between the two groups, both at admission and after n-RCT. In short term (1–6 months) period, significantly better results were observed in ELRR group by QLQ-C30 in: Global Health Status (p=0.003), Physical Functioning (p=0.004), Role Functioning (p=0.004), Emotional Functioning (p=0.004), Cognitive Functioning, Fatigue (p=0.005), Dyspnoea (p=0.005), Insomnia (p=0.05), Appetite loss (p=0.05), Constipation (p=0.05); and by QLQ-CR38 in: Body Image (p=0.03) and Defecation (p=0.025). At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the QLQCR38 still showed better results of ELRR vs. LTME in Body Image (p=0.006), Defecation Problems (p=0.01), and Weight Loss (p=0.005). At 3 years no statistically significant differences were observed between the two groups. Conclusions: In selected patient with rectal cancer, underwent ELRR by TEM or LTME, QoL testes at 3 years don’t show any statistical difference on examined items.