TME: increased rate of sphincter saving resections

0

10

20

30

40

50

60

70

80

90

100

0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 >10

Distance tumour to anus (cm)

AP

R / (

AP

R+

LA

R)

(%)

SRC trial TME trial

Nationwide decline in APR

Engel AF Col Dis 2005

APR % 1994 versus 1999

• No rise in hospital mortality

• Decline APR coincided with TME instruction

Determinants for success of sphincter preservation

• Young age• Good preoperative function• Proximal tumour location• Absence of radiotherapy• Wish of the patient

“Temporary” defunctioning stomas

• 19% of “temporary” stomas are never reversed• Increased risk in case of postoperative complications or secondary

constructed stomas

Den Dulk M Lancet oncol 2007

Stoma related problems

Noises 60.8%Smell 47.6%Bleeding 33.5%Irritation skin 33.0%Leaking 25.0%Pain 14.3%

Peeters KC J Clin Oncol 2005

Restrictions with regard to defaecation

RT+TME

TME

RT+TME

TME

no stoma

stoma

*

*

0 10 20 30 40 50 60

cinema / theatre visit

outdooractivities

household activities

* p < 0.01

Peeters KC J Clin Oncol 2005

20

40

60

80

100

Stoma No stoma p=n.s. p=0.009

5-10 cm 10-15 cm p=0.04 p=0.02

RT+TME

TME

p=n.s. p=0.009 p=0.04

→ APR patients are more satisfied about defaecation

Satisfaction about defaecation

Peeters KC J Clin Oncol 2005

Acceptance of faecal incontinence

Analysis of treatment and time trade-offs:

Bossema E Eur J Surg Oncol 2007

Quality of life: APR versus LAR

• Cochrane report no difference1

• Age-specific• Cultural differences• Religious considerations• Preoperative information

1Pachler J Cochrane Database Syst Rev 2005