• Katherine F Donovan, Katherine C Lee, Alison Ricardo, Natalie Berger, Antoinette Bonaccorso, Karim Alavi, Karen Zaghiyan, Alessio Pigazzi, Dana Sands, Teresa DeBeche-Adams, Sami A Chadi, Elisabeth C McLemore, John H Marks, Justin A Maykel, Sherief F Shawki, Scott R Steele, Matthew Albert, Mark H Whiteford, Fu-Yuan Cheng, Steven D Wexner, and Patricia Sylla.
• Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY.
• Ann. Surg. 2024 Sep 1; 280 (3): 363373363-373.

ObjectiveTo investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME).BackgroundProctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter phase II taTME trial demonstrated the safety of taTME in patients with stage I to III tumors.MethodsProspectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence [Fecal Incontinence Quality of Life (FIQL), Wexner], defecatory function [Colorectal Functional Outcome (COREFO)], urinary function (International Prostate Symptom Score), and sexual function (Female Sexual Function Index-female, International Index of Erectile Function-male) were assessed preoperatively (PQ), 3 to 4 months postileostomy closure (FQ1), and 12 to 18 months post-taTME [postoperative questionnaire 2 (FQ2)].ResultsAmong 83 patients who responded at all 3 time points, FIQL, Wexner, and COREFO significantly worsened postileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. International Prostate Symptom Score did not change relative to preoperative scores. For females, Female Sexual Function Index declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, International Index of Erectile Function declined with no change between FQ1 and FQ2.ConclusionsAlthough taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decision-making regarding taTME.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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