eP807 - Functional Outcomes after Transanal Total Mesorectal Excision (taTME) for Rectal Cancer: Results from the Phase II North American Multicenter Trial

Monday, June 3, 2024

10:54 AM – 10:59 AM ET, USA

Location: Room 318-320

ePoster Presenter(s)

Katherine F. Donovan, MD (she/her/hers)

Resident
New York Medical College
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Katherine C. Lee, MD, MS (she/her/hers)

Colorectal Surgery Fellow
Mount Sinai Hospital
Mount Sinai Hospital
New York, NY, United States

Disclosure information not submitted.
Dana Sands, MD

Staff Surgeon

Disclosure information not submitted.
JM

John Marks, MD, FACS, FASCRS

Chief of Colorectal Surgery
Lankenau Medical Center
Wynnewood, Pennsylvania, United States

Disclosure information not submitted.
Justin A. Maykel, MD (he/him/his)

Chief, Colorectal Surgery
UMass Memorial Medical Center
UMass Chan Medical
Worcester, Massachusetts, United States

Disclosure information not submitted.
Karim Alavi, n/a

Associate Professor of Surgery
University of Massachusetts Chan Medical School
Southborough, Massachusetts, United States

Disclosure information not submitted.
Karen Zaghiyan, MD

Assistant Professor of Surgery
Cedars-Sinai
Cedars Sinai Medical Center
Los Angeles, California, United States

Disclosure information not submitted.
MW

Mark H. Whiteford, Afilliate Professor of Surgery, OHSU

Director Colorectal Surgery
The Oregon Clinic. Providence Cancer Institute
Portland, Oregon, United States

Disclosure information not submitted.
Elisabeth McLemore, MD

Disclosure information not submitted.
SC

Sami A. Chadi, MD MSc FRCSC FACS FASCRS

Colorectal surgeon
University of Toronto
Toronto, Ontario, Canada

Disclosure information not submitted.
SS

Sherief Shawki, MD, FACS, FASCRS

Consultant, colon & Rectal surgery
Mayo Clinic Rochester
Rochester, Minnesota, United States

Disclosure information not submitted.
Scott Steele, MD MBA

President, Chairman, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Alessio Pigazzi, MD PhD

Professor of Surgery
Weill Cornell Medicine
Weill Cornell Medicine
New York, NY, United States

Disclosure information not submitted.
Matthew Albert, MD, FACS, FASCRS

Medical Director, Surgical Innovation DHSI
AdventHealth
Orlando, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
TD

Teresa DeBeche-Adams, FACS, FASCRS

Chairman, Department of Colorectal Surgery
AdventHealth Orlando
Orlando, Florida, United States

Disclosure information not submitted.
FC

Fu-Yuan Cheng, MS

Data scientist
Mount Sinai Clinical Data Science Team
New York, New York, United States

Disclosure information not submitted.
Steven D. Wexner, MD, PhD (Hon)

Chairman
Cleveland Clinic Florida
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Weston, Florida, United States

Disclosure information not submitted.

Author(s)

Patricia Sylla, MD (she/her/hers)

Chief of Colorectal Surgery
Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai
New York, New York, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: A prospective multicenter Phase II taTME trial conducted across 11 North American centers from 2015-2022 demonstrated the procedural and preliminary oncologic safety of sphincter-preserving taTME among 100 patients with stage I-III rectal tumors. We now report the short and long-term postoperative functional outcomes relative to preoperative baseline in this cohort.Methods/Interventions: Self-reported questionnaires were collected from patients enrolled in the Phase II taTME trial. Fecal continence (FIQL and Wexner), defecatory function (COREFO), urinary function (IPSS), and female/male sexual function (FSFI, IIEF) scores were assessed preoperatively (PQ), 3-4 months post-ileostomy closure (FQ1), and 12-18 months post-taTME (FQ2). Scores at all 3 time points were compared using Wilcoxon Signed-Rank test.Results/Outcomes: taTME was performed in 70 males and 30 females with median age 58 (IQR 49-62) and BMI 27.8 (IQR 23.9–31.8) kg/m2. Tumors were located a median of 5.8 (IQR 4.5-7.0) cm from the anal verge and treated with neoadjuvant treatment in 71%. Intersphincteric resection was performed in 36% and handsewn anastomoses in 54%. Ileostomy was created in all 100 patients and reversed in 98 after a median of 5.8 (IQR 3.1-7.4) months. The PQ, FQ1, and FQ2 completion rate was 99%, 94%, and 91%. Median time from taTME to FQ1 was 9.5 (IQR 7.2–11.0) months and to FQ2 was 18.7 months (IQR 16.0–20.1). In 85 patients who completed questionnaires at all time points, FIQL, Wexner, and COREFO in all domains significantly worsened between PQ and FQ1 (p < 0.01). Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved (p < 0.05; Fig 1A-B). FIQL depression and embarrassment did not change between FQ1 and FQ2 (p=0.18 and p=0.30, respectively; Fig 1A). There was no change in urinary function (IPSS) at any time (Fig 1C). For females, FSFI significantly declined for desire, arousal, lubrication, orgasm, and satisfaction between PQ and FQ1 (p < 0.05) but did not change between FQ1 and FQ2 (Fig 1F). In males, IIEF score significantly declined across all domains postoperatively (p < 0.05) with no change between FQ1 and FQ2 (Fig 1E).Conclusion/

Discussion: Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains significantly improved by 12 months. Urinary function was preserved while sexual function significantly declined in both males and females without significant improvement by 18 months. The observed prevalence and persistence of depression and embarrassment related to fecal continence beyond 12 months provides opportunities for intervention and support.Figure 1

Questionnaire scores pre-surgery (PQ), 3-4 months post-ileostomy closure (FQ1), 12-18 months post-taTME (FQ2). * signifies statistical significance (p < 0.05). A. Fecal Incontinence Quality of Life (FIQL). B. Wexner. C. International Prostate Symptom Score (IPSS). D. COREFO. E. International Index of Erectile Function (IIEF) (n=58). F. Female Sexual Function Index (FSFI) (n=25).