In this retrospective, propensity score-adjusted cohort study, we compared long-term quality of life (QoL) and functional outcomes in patients undergoing transanal total mesorectal excision (taTME) versus traditional abdominal TME (abTME) for rectal cancer. Given the increasing use of taTME and the lack of long-term data, we aimed to assess whether this approach offers advantages in postoperative recovery from the patient’s perspective. A total of 249 patients treated between 2013 and 2022 were included, with 187 undergoing taTME and 62 undergoing abTME. After adjustment for baseline differences using propensity score matching, we analyzed QoL data collected via the EORTC QLQ-C30 questionnaire at multiple follow-up intervals up to five years. Our findings showed that overall long-term QoL and functional outcomes were comparable between the two techniques.
Isolated statistically significant differences were observed at individual time points - for example, slightly lower QoL scores and increased rates of diarrhea and constipation in the taTME group after three to five years - but these differences were of questionable clinical relevance. In summary, our data suggest that taTME and abTME yield similar patient-reported outcomes over the long term, and while taTME may result in temporary or specific functional disadvantages, these do not appear to impact overall recovery or patient satisfaction in a meaningful way.
Interview with Marie Klein and Dr. med. Yanic Ammann (St. Gallen)
What inspired you to conduct the study?
Thanks to total mesorectal excisoin (TME), as well as the progress in neoadjuvant and adjuvant therapies, the prognosis for patients with rectal cancer has significantly improved. The transanal TME (taTME) is a relatively new surgical technique gaining popularity. Several studies have demonstrated equivalent outcomes in terms of short-term postoperative outcomes, local recurrence rates, and long-term survival of taTME compared to the conventional abdominal TME (abTME). This prompted us to ask how taTME affects patients’ short- and especially long-term quality of life (QoL).
Where there any unexpected findings?
Overall, we expected a similar QoL and physical functioning in taTME and abTME. The results showed that patients who underwent taTME reported slightly lower QoL scores at certain time points. However, the clinical relevance of these differences is debatable. Overall, taTME and abTME appear to have comparable long-term QoL and functional outcomes. A surprising finding was that although more patients, especially in the abTME group, reported functional impairments such as diarrhea and fatigue after three years, overall QoL actually improved over time. Isolated functional issues appear to have relatively little impact on overall QoL.
What is the direct impact on surgeons work?
Our findings indicate that patients undergoing taTME experience compareable long-term QoL to those treated with abTME. taTME can be performed with confidence regarding QoL. Nevertheless, patients must be well informed about potential impacts on QoL associated with TME regardless of the surgical approach.
What is your learning point from this project?
This project has once again demonstrated the importance of distinguishing between statistically significant and clinically relevant results. Even though certain parameters differed statistically at specific time points, these differences do not necessarily translate into meaningful effects in patients’ daily lives.
Are there any subsequent projects planned?
At the moment, there are no further analysis planned comparing taTME with abTME. Our study group will shortly provide data regarding the comprehensive complicatoins index in rectal cancer surgery and comparing shor- and long-term postoperative outcomes between early- (younger than 50 years) and late-onset colorectal cancer.
