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Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have investigated long-term functional outcomes and patients’ quality of life. The aim of this study was to compare functional outcomes and quality of life before and after transanal total mesorectal excision in 1-year follow-up. Between February 2016 and April 2019, 51 patients with mid- or low rectal cancer undergoing transanal total mesorectal excision at Fondazione Policlinico Universitario “A. Gemelli” were enrolled. Neoadjuvant radiochemotherapy was administered to locally advanced cancers. Before and after the surgical procedure, patients were examined collecting clinical data, LARS score, CCFIS, SF36 and FIQL, performing anorectal manometry and endoanal ultrasonography. Thirty-three patients were eligible and completed the 12 months follow-up. After treatment, six patients (18.2%) had minor or major LARS. A mild but significant increase of CCFIS was documented. Only the mean resting pressure significantly decreased at follow-up. No sphincter lesions were documented. FIQL assessment showed significant reduction of lifestyle, coping/behaviour, and embarrassment, while an increase of general health was assessed by SF36. At both uni- and multivariate analyses the neoadjuvant radiochemotherapy had a not negligible impact. Transanal total mesorectal excision represents a safe approach to patients treated for mid- or low rectal cancer. The functional sequelae can be limited in severity, with a low incidence of minor/major LARS, particularly faecal incontinence. These results are comparable to those obtained by the conventional total mesorectal excision.

Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have investigated long-term functional outcomes and patients’ quality of life. The aim of this study was to compare functional outcomes and quality of life before and after transanal total mesorectal excision in 1-year follow-up. Between February 2016 and April 2019, 51 patients with mid- or low rectal cancer undergoing transanal total mesorectal excision at Fondazione Policlinico Universitario “A. Gemelli” were enrolled. Neoadjuvant radiochemotherapy was administered to locally advanced cancers. Before and after the surgical procedure, patients were examined collecting clinical data, LARS score, CCFIS, SF36 and FIQL, performing anorectal manometry and endoanal ultrasonography. Thirty-three patients were eligible and completed the 12 months follow-up. After treatment, six patients (18.2%) had minor or major LARS. A mild but significant increase of CCFIS was documented. Only the mean resting pressure significantly decreased at follow-up. No sphincter lesions were documented. FIQL assessment showed significant reduction of lifestyle, coping/behaviour, and embarrassment, while an increase of general health was assessed by SF36. At both uni- and multivariate analyses the neoadjuvant radiochemotherapy had a not negligible impact. Transanal total mesorectal excision represents a safe approach to patients treated for mid- or low rectal cancer. The functional sequelae can be limited in severity, with a low incidence of minor/major LARS, particularly faecal incontinence. These results are comparable to those obtained by the conventional total mesorectal excision.

Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have investigated long-term functional outcomes and patients’ quality of life. The aim of this study was to compare functional outcomes and quality of life before and after transanal total mesorectal excision in 1-year follow-up. Between February 2016 and April 2019, 51 patients with mid- or low rectal cancer undergoing transanal total mesorectal excision at Fondazione Policlinico Universitario “A. Gemelli” were enrolled. Neoadjuvant radiochemotherapy was administered to locally advanced cancers. Before and after the surgical procedure, patients were examined collecting clinical data, LARS score, CCFIS, SF36 and FIQL, performing anorectal manometry and endoanal ultrasonography. Thirty-three patients were eligible and completed the 12 months follow-up. After treatment, six patients (18.2%) had minor or major LARS. A mild but significant increase of CCFIS was documented. Only the mean resting pressure significantly decreased at follow-up. No sphincter lesions were documented. FIQL assessment showed significant reduction of lifestyle, coping/behaviour, and embarrassment, while an increase of general health was assessed by SF36. At both uni- and multivariate analyses the neoadjuvant radiochemotherapy had a not negligible impact. Transanal total mesorectal excision represents a safe approach to patients treated for mid- or low rectal cancer. The functional sequelae can be limited in severity, with a low incidence of minor/major LARS, particularly faecal incontinence. These results are comparable to those obtained by the conventional total mesorectal excision.

La tesi si prefigge di ricostruire il quadro normativo e concettuale che si è venuto ad enucleare a seguito dell’abrogazione della legge n.1369/1960 in tema di interposizione di manodopera, nonché della contemporanea dilatazione della responsabilità solidale del committente di un appalto di opera o servizi in forza del disposto dell’art. 29, d.lgs. n. 276/2003. Nella prospettiva di attribuire al regime di solidarietà particolare attenzione l’Autore descrive, nel primo capitolo, tutte le ipotesi di responsabilità solidale presenti nel Codice civile con l’intento di individuare una base comune a tutte le fattispecie prese in esame. Nel capitolo secondo si analizzano le evoluzioni dell’art. 29, d.lgs. n. 276/2003 e le numerose modifiche che tale norma ha dovuto sopportare, estendendo l’analisi al regime contributivo e fiscale, nonché alla disciplina relativa alla salute e sicurezza dei lavoratori. Il terzo capitolo, infine, analizza gli aspetti critici della solidarietà negli appalti, dal tema della successione nel contratto di appalto da parte di un nuovo appaltatore a quello della compatibilità delle clausole sociali con il diritto europeo passando per la derogabilità al suddetto regime da parte della contrattazione collettiva, alle ipotesi di simulazione di contratti di appalto, senza tralasciare di analizzare l’ambito di applicazione della responsabilità solidale di cui all’art. 29, d.lgs. n. 276/2003 anche ad altre fattispecie negoziali attigue all’appalto. L’analisi si conclude, poi, con la confutazione dell’opinione dottrinale secondo la quale le esternalizzazioni d’impresa realizzate attraverso contratti di appalto porterebbero all’insorgenza di ipotesi di codatorialità., The thesis aims to reconstruct the conceptual framework and that it has come to devise following the repeal of the law n.1369/1960 concerning the interposition of labor, as well as the contemporary expansion of joint liability of the buyer of a tender contract for work or services under the provisions of art. 29, Legislative Decree n. 276/2003. In the perspective of giving special attention to the system of joint and several liability in tender contracts the author describes, in the first chapter, all cases of joint and several liability in the Italian Civil Code with the intent to establish a common base in all cases examined. In the second chapter we analyze the evolution of the art. 29, Legislative Decree n. 276/2003 and the many changes that this standard has had to endure, extending the analysis to social insurance contribution and tax, as well as the rules on the health and safety of workers. The third chapter analyzes the critical aspects of joint and several liability in tender contracts, the issue of succession in the contract by a new contractor to that of the compatibility of social clauses with European law through the derogation to that scheme by the collective bargaining, the simulation assumptions of tender contracts, without neglecting to analyze the scope of joint liability in art. 29 , Legislative Decree n. 276/2003 also to other cases adjacent negotiating. The analysis concludes, then, with the refutation doctrinal opinion according to which the outsourcing business achieved through procurement contracts would lead to the onset of hypotheses of joint employment doctrine.