Anorectal and urogenital functional outcome after robotic and transanal total mesorectal excision for rectal cancer: a propensity score-matched analysis

Abstract

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.