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Master's Dissertation
DOI
10.11606/D.5.2018.tde-23042018-123357
Document
Author
Full name
Carlos Ramon Silveira Mendes
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Araujo, Sergio Eduardo Alonso (President)
Campos, Fábio Guilherme Caserta Maryssael de
Seid, Victor Edmond
Martinez, Carlos Augusto Real
Title in Portuguese
Impacto da microcirurgia endoscópica transanal sobre a função anorretal: avaliação clínica, funcional e da qualidade de vida
Keywords in Portuguese
Doenças retais
Incontinência fecal
Microcirurgia endoscópica transanal
Neoplasias colorretais
Neoplasias retais
Procedimento cirúrgico minimamente invasivo
Qualidade de vida
Abstract in Portuguese
Introdução: Descrita em 1983 e de sólida aplicação clínica, o impacto da microcirurgia endoscópica transanal (TEM) sobre a função anorretal permanece pouco conhecido. Os objetivos do presente estudo foram avaliar o impacto da TEM na função anorretal conforme avaliações clínicas (Wexner score) e funcional (manometria anorretal) antes e após a cirurgia. Método: Prospectivamente, 23 pacientes consecutivos com lesões retais foram operados com o uso do equipamento TEO® (Karl Storz, Tuttlingen, Alemanha). Para todos os pacientes, o valor do escore de Wexner foi obtido antes e após a cirurgia (7, 30 e 90 dias), e a eletromanometria anorretal foi realizada antes da cirurgia e também no pós-operatório (30 e 90 dias). Resultados: Quatorze pacientes eram homens. A idade média foi 53,7 (24-81) anos. A distância média da lesão à linha pectínea foi de 7 (2-15) cm. A histopatologia revelou adenoma em 14 (61%), tumor neuroendócrino em 5 (21,7%), carcinoma invasivo em 3 (13%) e pólipo hiperplásico em 1 (4,3%) caso. A duração média do seguimento pós-operatório foi de 5 (3-7) meses. O escore de Wexner foi significativamente menor aos 30 dias em comparação com 7 dias (Wilcoxon, p = 0,03). A capacidade retal foi significativamente menor aos 30 dias após a cirurgia e recuperada aos 90 dias após a cirurgia (ANOVA, p = 0,04). Conclusões: Após TEM, um impacto modesto na função anorretal pode ser observado. O comprometimento transitório resulta de perda de capacidade retal e não por comprometimento dos esfíncteres anais cessando completamente 90 dias após a cirurgia. Em última análise, não conseguimos detectar um impacto na qualidade de vida após TEM
Title in English
Impact of transanal endoscopic microsurgery on anorectal function: a prospective clinical, functional, and quality of life investigation before and after surgery
Keywords in English
Colorectal neoplasms
Fecal incontinence
Minimally invasive surgical procedures
Quality of life
Rectal diseases
Rectal neoplasms
Transanal endoscopic microsurgery
Abstract in English
Background: The impact of transanal endoscopic microsurgery (TEM) on anorectal function remains poorly available, particularly when considering that the technique involves undertaking full- or partial-thickness excision of the rectal wall. Moreover, in spite of wide adoption of TEM, its impact on quality of life remains unknown since most evidence derives from retrospective studies. Objective: The objectives of the present study were to evaluate the impact of TEM on sphincter function determined by clinical (Wexner score), functional (anorectal manometry), and quality of life (FIQL) evaluations conducted before and after surgery. Design: prospective, observational, single-center, 23 consecutive patients with rectal lesions underwent were operated on using the TEO® equipment (Karl Storz, Tuttlingen, Germany). Wexner and FIQL scores were obtained before and after surgery (7 days, 30 days and 90 days postoperatively). Anorectal manometry was obtained before surgery, and postoperatively after 30 and 90 days. Main Outcome Measures: Wexner and FIQL scores; anorectal manometry results. Results: Fourteen patients were men. Mean age was 53.7 (24-81) yrs. Mean distance from the lesion to the dentate line was 7 (2-15) cm. A full- thickness resection was undertaken in 18 (78.3%) cases. Histopathology revealed adenoma in 14 (61%), neuroendocrine tumor in 5 (21.7%), invasive carcinoma in 3 (13%), and hyperplastic polyp in 1 (4.3%) case. Postoperative rectal wound separation occurred in 2 patients and 1 patient developed atrial fibrillation. The mean duration of postoperative follow-up was 5 (3-7) months. Overall, Wexner score significantly declined between postoperative days 7 and 30 (Wilcoxon, p = 0.03). Rectal compliance exhibited significant decline 30 days after surgery and recovery at 90 days after surgery (ANOVA, p = 0.04). It was not possible to measure any difference in the FIQL results before and after surgery. Limitations: small sample size; limited follow-up. Conclusions: Following TEM, a modest impact on anorectal function could be confirmed. Interestingly, anorectal function impairment after surgery was not due to sphincter dysfunction, but resulted from loss of rectal compliance. Ultimately, we could not detect a significant impact on quality of life after TEM
 
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Publishing Date
2018-04-24
 
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