Pak Chiu Wong, Felix Che Lok Chow, Wai Lun Law, Chi Chung Foo
{"title":"直肠癌机器人和经肛门全肠系膜切除术后的肛门直肠和泌尿生殖功能结局：倾向评分匹配分析。","authors":"Pak Chiu Wong, Felix Che Lok Chow, Wai Lun Law, Chi Chung Foo","doi":"10.1007/s10151-025-03172-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted total mesorectal excision (RaTME) and transanal TME (TaTME) are well-established approaches for rectal cancer with promising oncological outcomes. Concerns about postoperative defecatory, urinary, and sexual dysfunction have been raised and the impact on patients' quality of life remained uncertain. This study compared anorectal and urogenital functional outcomes after RaTME and TaTME.</p><p><strong>Methods: </strong>Patients with mid to low rectal cancer who underwent sphincter-saving surgery between January 2016 and December 2021 were reviewed. Questionnaires regarding low anterior resection syndrome (LARS), Wexner incontinence score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered at 1, 3, 6, and 12 months after index operation without stoma or after stoma closure.</p><p><strong>Results: </strong>Two hundred patients were included with 108 and 92 patients in the RaTME and TaTME group, respectively. After matching, 74 patients were analyzed in each group. LARS scores were significantly lower in the RaTME group than the TaTME group at 6 months (27 [interquartile range (IQR) 13-36] vs 30 [IQR 24-39], p = 0.038) but similar at 12 months (27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369) after stoma closure. Urinary function deteriorated after both operations but recovered at 6 months after RaTME and 12 months after TaTME. For sexual function, IIEF scores remained similar in the two groups.</p><p><strong>Conclusion: </strong>RaTME provided better anorectal function with lower LARS score at initial postoperative 6 months but similar after 1 year. Urinary function recovered earlier at 6 months after RaTME while sexual function was comparable between two groups.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"141"},"PeriodicalIF":2.9000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259797/pdf/","citationCount":"0","resultStr":"{\"title\":\"Anorectal and urogenital functional outcome after robotic and transanal total mesorectal excision for rectal cancer: a propensity score-matched analysis.\",\"authors\":\"Pak Chiu Wong, Felix Che Lok Chow, Wai Lun Law, Chi Chung Foo\",\"doi\":\"10.1007/s10151-025-03172-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Robotic-assisted total mesorectal excision (RaTME) and transanal TME (TaTME) are well-established approaches for rectal cancer with promising oncological outcomes. Concerns about postoperative defecatory, urinary, and sexual dysfunction have been raised and the impact on patients' quality of life remained uncertain. This study compared anorectal and urogenital functional outcomes after RaTME and TaTME.</p><p><strong>Methods: </strong>Patients with mid to low rectal cancer who underwent sphincter-saving surgery between January 2016 and December 2021 were reviewed. Questionnaires regarding low anterior resection syndrome (LARS), Wexner incontinence score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered at 1, 3, 6, and 12 months after index operation without stoma or after stoma closure.</p><p><strong>Results: </strong>Two hundred patients were included with 108 and 92 patients in the RaTME and TaTME group, respectively. After matching, 74 patients were analyzed in each group. LARS scores were significantly lower in the RaTME group than the TaTME group at 6 months (27 [interquartile range (IQR) 13-36] vs 30 [IQR 24-39], p = 0.038) but similar at 12 months (27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369) after stoma closure. Urinary function deteriorated after both operations but recovered at 6 months after RaTME and 12 months after TaTME. For sexual function, IIEF scores remained similar in the two groups.</p><p><strong>Conclusion: </strong>RaTME provided better anorectal function with lower LARS score at initial postoperative 6 months but similar after 1 year. 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引用次数: 0
摘要
背景：机器人辅助全肠系膜切除（RaTME）和经肛门全肠系膜切除（TaTME）是治疗直肠癌的成熟方法，具有良好的肿瘤预后。对术后排便、泌尿和性功能障碍的担忧已经增加，对患者生活质量的影响仍不确定。本研究比较了RaTME和TaTME术后肛门直肠和泌尿生殖功能的结果。方法：回顾性分析2016年1月至2021年12月期间行保括约肌手术的中低位直肠癌患者。在无造口或造口后1、3、6和12个月分别进行低前切除术综合征（LARS）、Wexner失禁评分、国际前列腺症状评分（IPSS）和国际勃起功能指数（IIEF-5）问卷调查。结果：纳入200例患者，其中RaTME组108例，TaTME组92例。配对后，每组分析74例患者。在造口后6个月，RaTME组的LARS评分显著低于TaTME组（27[四分位间距（IQR） 13-36] vs 30 [IQR 24-39], p = 0.038），但在12个月时，两者相似（27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369）。两种手术后泌尿功能均恶化，但分别于RaTME术后6个月和TaTME术后12个月恢复。在性功能方面，两组的IIEF分数保持相似。结论：RaTME术后6个月的LARS评分较低，但术后1年的评分与RaTME术后6个月的评分相近。术后6个月，泌尿功能恢复较早，两组间的性功能恢复无明显差异。
Anorectal and urogenital functional outcome after robotic and transanal total mesorectal excision for rectal cancer: a propensity score-matched analysis.
Background: Robotic-assisted total mesorectal excision (RaTME) and transanal TME (TaTME) are well-established approaches for rectal cancer with promising oncological outcomes. Concerns about postoperative defecatory, urinary, and sexual dysfunction have been raised and the impact on patients' quality of life remained uncertain. This study compared anorectal and urogenital functional outcomes after RaTME and TaTME.
Methods: Patients with mid to low rectal cancer who underwent sphincter-saving surgery between January 2016 and December 2021 were reviewed. Questionnaires regarding low anterior resection syndrome (LARS), Wexner incontinence score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered at 1, 3, 6, and 12 months after index operation without stoma or after stoma closure.
Results: Two hundred patients were included with 108 and 92 patients in the RaTME and TaTME group, respectively. After matching, 74 patients were analyzed in each group. LARS scores were significantly lower in the RaTME group than the TaTME group at 6 months (27 [interquartile range (IQR) 13-36] vs 30 [IQR 24-39], p = 0.038) but similar at 12 months (27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369) after stoma closure. Urinary function deteriorated after both operations but recovered at 6 months after RaTME and 12 months after TaTME. For sexual function, IIEF scores remained similar in the two groups.
Conclusion: RaTME provided better anorectal function with lower LARS score at initial postoperative 6 months but similar after 1 year. Urinary function recovered earlier at 6 months after RaTME while sexual function was comparable between two groups.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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