Long-term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer.
BACKGROUND
Permanent colostomy, pelvic dissection, and radiotherapy after abdominoperineal resection can put quality of life and sexual and urinary function at risk; however, there are limited data using validated instruments on patients undergoing abdominoperineal resection regarding these outcome measures.


OBJECTIVE
We evaluated the quality of life and the sexual and urinary function of patients undergoing abdominoperineal resection for rectal cancer and compared the outcomes of patients who received and did not receive pre- or postoperative pelvic radiotherapy.


METHODS
European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and CR38, International Consultation on Incontinence Questionnaire, American Urological Association Symptom Index, Brief Sexual Function Inventory for men, and sexual function module of the Cancer Rehabilitation Evaluation System for women were mailed to 219 patients who underwent abdominoperineal resection between 1994 and 2004.


RESULTS
One-hundred forty-three patients responded (response rate, 65%), of whom 55 (38%) were treated with surgery alone and 88 (62%) received pelvic radiotherapy. Generic and disease-specific quality of life and sexual and urinary function were similar between patients not receiving and receiving pelvic radiotherapy. However, a proportion of patients experienced adverse quality of life after surgery, and this was associated with a younger age, male sex, and sexual inactivity. In sexually active men, sexual function after abdominoperineal resection was diminished compared with population-based controls.


CONCLUSIONS
This study was limited by the lack of baseline data and cross-sectional nature of survey.


CONCLUSIONS
Quality of life and sexual function can be impaired after abdominoperineal resection, although the impact of pelvic radiotherapy appears to be limited. Indication and timing of radiotherapy should be based on oncological indications, but quality of life and functional outcomes should be considered when counseling patients.
Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Michael S
MS
Kasparek
Imran
I
Hassan
Robert R
RR
Cima
Dirk R
DR
Larson
Rachel E
RE
Gullerud
Bruce G
BG
Wolff
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology*