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Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life.
MedLine Citation:
PMID:  23883494     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Anal dilation during tumour excision with transanal endoscopic microsurgery (TEM) has caused concerns regarding postoperative anal function. We sought to determine whether TEM affects anorectal function and quality of life.
METHODS: All patients undergoing TEM between March 2007 and December 2008 were considered for inclusion. We excluded patients who were treated with subsequent radical resection, unavailable for interview or deceased. Patients were interviewed by phone to measure the preoperative and postoperative function using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core 30 (EORTC QLQ-C30) and Core 38 (CR38) instruments, the Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life (FIQL) questionnaires. Statistical analysis involved the Wilcoxon signed rank test and Spearman rank correlation coefficient.
RESULTS: Forty patients received TEM; 30 of them met all inclusion criteria and agreed to participate. The median age was 70 (42-93) years, and median follow-up time between the interview and the operation was 365 (55-712) days. Tumours excised included 19 adenomas, 8 carcinomas and 3 carcinoid tumours. The median distance from the tumour to the anal verge was 6.5 (2-13) cm. Median length of stay was 1 (0-12) day. For most aspects of quality of life, there were no detectable differences after surgery. The EORTC QLQ-C30 showed a significant improvement in diarrhea (27.8 v. 10, p = 0.002). The FIQL scores improved with surgery (3.59 v. 3.85, p = 0.020). There was no difference in pre- versus postoperative FISI scores (6.7 v. 6.3, p = 0.93).
CONCLUSION: Despite a large operating rectoscope, TEM improves quality of life related to fecal incontinence and does not have a negative impact on fecal continence.
Abstract available from the publisher.
Anneke Planting; P Terry Phang; Manoj J Raval; Carl J Brown
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  56     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  243-8     Citation Subset:  IM    
Department of Surgery, St. Paul's Hospital, Vancouver and the University of British Columbia, Vancouver, BC.
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