Quality of Life

Quality of life refers to a persons general well being and encompasses all emotional, social and physical aspects of an individual’s life. Undergoing surgery and other treatments such as chemotherapy and radiation therapy, is not easy and can have a significant impact on a person’s life. Care and support during this difficult time is extremely important. This support should also continue during the follow up / surveillance period during which other symptoms may become more prominent, in particular regarding bowel, urinary and sexual dysfunction. Such functional problems cover a wide spectrum of symptoms and degrees of severity, and can subsequently affect emotional well-being and quality of life.

We therefore welcome you to complete a set of questionnaires to explore these functional aspects before and after surgery at regular intervals. In order to highlight any changes, we invite you to answer the questions at 3 and 6 months after surgery for the first year and then on an annual basis during your routine follow up period (see flow chart below). The surveys will help you and us identify any areas that may need attention and further investigation, to then be able to discuss treatment options that can improve your symptoms. All information is kept strictly confidential and only viewed by the medical team in charge of your care.

How do I access the questionnaires?

The questionnaires can be accessed and completed online via the educational TaTME website (LINK: www.TATME.surgery). You will therefore not have to attend any additional hospital appointments just for this.   Your surgical team will provide you with your unique User ID (6 digits, usually starting with 100). You will need to enter this access code and your date of birth to view the questionnaire.

Further information on data collection and quality of life surveys can be found in this patient information sheet, here: PDF of Patient Info Sheet

When should I complete the questionnaire?
If you don’t have a stoma:

If you do have a stoma:

Rectal cancer information

To improve oncological and functional outcomes of patients with rectal cancer new surgical techniques are being developed. The adoption of the Total Mesorectal Excision (TME) technique has resulted in better oncological outcome in the last decades. The addition of neoadjuvant therapy has further improved oncological outcome. The minimal invasive laparoscopic resection of rectal cancer has shown to be safe and to result in improved short-term outcomes and reduced morbidity. Nevertheless, the laparoscopic resection of mid and low rectal cancer remains challenging due to the anatomy of the narrow pelvis and is associated with a relative high risk of resections with tumour involved circumferential resection margins (CRM) resulting in increased risk of recurrence.The introduction of transanal single port surgery has led to the TaTME technique. In attempt to improve the quality of the TME procedure in low rectal cancer and further improve oncological results the transanal total mesorectal excision (TaTME) has been developed, in which the rectum is dissected transanally according to TME principles.

 First series have been described since 2010 and although randomised evidence is still lacking this new technique has shown to be feasible and safe. The rectum including the total mesorectum is mobilised transanally in a reversed way with minimally invasive surgery including high quality imaging techniques. The TaTME technique for low and mid rectal cancer has shown to have potential benefits: better specimen quality with less CRM involvement, less morbidity as result of avoiding extraction wounds in the majority of patients and more sphincter saving rectal resections without compromising oncological outcomes. Currently, cohort series have demonstrated potential benefits of the TaTME for rectal cancer including a low rate of involved CRM, low morbidity rate and a high rate of sphincter saving procedures. Jurriaan Tuynman, MD, PhD,  colorectal surgeon has introduced the technique in the VU medical center Amsterdam in 2013. Colin Sietses, MD, PhD, Colorectal surgeon has introduced this technique in Netherlands, EDE, since 2012.

TaTME Course information

The TaTME course is an intensive two-day, hands on course enables surgeons to become familiar with ins and outs of the TaTME (trans anal reversed total mesorectal excision) technique. This requires both single port and specific anatomical and technical skills. The first day is a combination of a live TaTME procedure in theatre, lectures and discussions involving technique and pitfalls of TaTME surgery. We focus to a small group of participants ensuring optimal feedback and discussions. The second day the surgeons will have hands-on cadaver training with proctors after a demonstration of the anatomy. In the cadaver lab the procedural setup, the purse string suture, the dissection and the anastomosis can be trained in fresh frozen cadavers, 2 surgeons/cadaver. A website with full accessible information and newsletters is supporting the course. A parallel course is running on the first day for the scrub team; The TaTME procedure is a team effort; The first day we offer specific technical scrub-course in the Amstel Academy.

The second day the scrub nurse will participate in the hands on cadaver training. During the lectures there will be time for product information and lessons for both surgeons and scrub team. During the hands on cadaver training the industry is encouraged to help and participate in the course. At the end of the first day we have organized a social program which includes a diner and sightseeing in the canals of Amsterdam. Co-operation with u  s will be an unique opportunity to exchange thoughts how new developments in technology can be translated to daily clinical practice. We would like to collaborate with you during substantial time which allows a reliable partnership in clinical education. Patient safety is primary goal. Introduction of new surgical technology has to be accompanied with training guidance and monitoring in order to achieve patient safety and better surgical outcome.

 Contribution

The contribution for this course will be €750 for the surgeon and € 250 for a nurse. This fee also includes the social program at the end of the first day. The fee does not include the travel & hotel arrangements.”

Surgery and recovery

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (whether it affects the inner lining of the rectum only, involves the whole rectum, or has spread to lymph nodes, nearby organs, or other places in the body).
  • Whether the tumor has spread into or through the bowel wall.
  • Where the cancer is found in the rectum.
  • Whether the bowel is blocked or has a hole in it.
  • Whether all of the tumor can be removed by surgery.
  • The patient’s general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).