title: Is sphincter preservation reasonable in all patients with rectal cancer?
abstract: OBJECTIVE
  Modern sphincter-preserving surgery for ultralow rectal carcinoma has a comparable oncological radicality to abdomino-perineal extirpation (APE). The aim of this study was to assess the long-term morbidity of ultralow anterior resection (ULAR) and its impact on quality of life (QoL) METHODS: The medical records of 142 consecutive patients who underwent surgery for ultralow rectal carcinoma from January 1991 to December 2004 were reviewed retrospectively. The rate of rehospitalisation and rate of non-reversed temporary stomas ("failure" stoma) were analysed. Generic and cancer-specific quality of life questionnaires were used to assess quality of life.
  
  
  RESULTS
  There were a total of 82 ULAR and 60 APE. After ULAR, 25 (30.5%) of the patients were readmitted, stenosis and anastomotic leakage being the main reasons. After APE, only 2 (3.3%) of the patients were readmitted (P < 0.001). The rate of patients with a permanent stoma after sphincter-saving surgery was 22.0%. The failure rate was higher for older patients (P = 0.005) and for coloanal pull-through anastomosis (P = 0.001). The exploratory analysis revealed a negative impact of a "failure" stoma on QoL.
  
  
  CONCLUSIONS
  Severe long-term morbidity and high failure rate of stoma reversal have a significantly worse impact on QoL after ULAR; therefore, APE is a valid alternative to ULAR, especially in elder patients with planned coloanal pull-through anastomosis.
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, CH-9007 St. Gallen, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Fischer
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.forename: Jochen
authors.initials: J
authors.lastname: Lange
authors.forename: Andreas
authors.initials: A
authors.lastname: Zerz
authors.forename: Franc H
authors.initials: FH
authors.lastname: Hetzer
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas; D011795:Surveys and Questionnaires; D017211:Treatment Failure