Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results

• Published in: International journal of colorectal disease Vol. 32; no. 12; pp. 1677 - 1685
• Main Authors: Clermonts, S. H. E. M., van Loon, Y. T., Schiphorst, A. H. W., Wasowicz, D. K., Zimmerman, D. D. E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anal Canal - physiopathology; Anal Canal - surgery; Fecal incontinence; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Feces; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Intestinal Polyps - pathology; Intestinal Polyps - physiopathology; Intestinal Polyps - surgery; Laparoscopy; Male; Medicine; Medicine & Public Health; Microsurgery; Middle Aged; Morbidity; Original Article; Patient education; Patients; Polyps; Polyps (Pathology); Proctology; Prospective Studies; Rectal Neoplasms - pathology; Rectal Neoplasms - physiopathology; Rectal Neoplasms - surgery; Rectum; Risk Factors; Severity of Illness Index; Surgery; Time Factors; Transanal Endoscopic Surgery - adverse effects; Transanal Endoscopic Surgery - methods; Treatment Outcome; Tumors; Fecal incontinence; TAMIS; Rectal; Fecal incontinence severity index; Transanal endoscopic microsurgery; Transanal minimally invasive surgery; Anorectal function
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-017-2893-6

Purpose Transanal minimally invasive surgery (TAMIS) is gaining worldwide popularity as an alternative for the transanal endoscopic microsurgery (TEMS) method for the local excision of rectal polyps and selected neoplasms. Data on patient reported outcomes regarding short-term follow-up are scarce; data on functional outcomes for long-term follow-up is non-existent. Methods We used the fecal incontinence severity index (FISI) to prospectively assess the fecal continence on the intermediate-term follow-up after TAMIS. The primary outcome measure is postoperative fecal continence. Secondary outcome measures are as follows: perioperative and intermediate-term morbidity. Results Forty-two patients (m = 21:f = 21), median age 68.5 (range 34–94) years, were included in the analysis. In four patients (9.5%), postoperative complications occurred. The median follow-up was 36 months (range 24–48). Preoperative mean FISI score was 8.3 points. One year after TAMIS, mean FISI score was 5.4 points ( p  = 0.501). After 3 years of follow-up, mean FISI score was 10.1 points ( p  = 0.01). Fecal continence improved in 11 patients (26%). Continence decreased in 20 patients (47.6%) (mean FISI score 15.2 points, [range 3–31]). Conclusions This study found that the incidence of impaired fecal continence after TAMIS is substantial; however, the clinical significance of this deterioration seems minor. The present data is helpful in acquiring informed consent and emphasizes the need of proper patient information. Functional results seem to be comparable to results after TEMS. Furthermore, we confirmed TAMIS is safe and associated with low morbidity.