부산대학교 도서관

Aim: Management of the rectal defect after transanal endoscopic microsurgery (TEM) is a matter of debate. Data are lacking on long term outcomes and continence of patients with open or closed rectal defect. We sought to analyse these in a retrospective cohort study. Methods: Patients undergoing TEM via the Specialist Early Rectal Cancer (SERC) MDT between 2012 and 2019 were included from a prospectively maintained database. These were divided into two groups – open and closed, based on management of rectal defect. Patient demographics and outcomes, including pre‐ and postoperative oncological staging, morbidity, mortality, length of stay and faecal incontinence severity score (FISI) scores were assessed. Results: A total of 170 matched patients were included (70‐open, 100‐closed rectal defects). Short‐term complications (bleeding, infection, urinary retention and infection, length of stay and pain) were 18.8% with no significant difference between the two groups (22% vs. 16%). Most of the defects were well healed upon endoscopic follow‐up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus (p = 0.87) or stricture (p = 0.79) but a significant difference in post‐TEMS FISI scores in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02). Conclusion: There are pros and cons associated with both rectal defect management approaches. Long‐term complications should be expected and actively followed up. Patients should be thoroughly counselled about these and possible deterioration in continence post‐TEM. [ABSTRACT FROM AUTHOR]