title: Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer.
abstract: BACKGROUND
  It is widely believed that quality of life is worse after abdominoperineal excision then after low anterior resection. However, this view is not supported unequivocally.
  
  
  OBJECTIVE
  The aim of this study was to compare quality of life in patients 1 year following low anterior resection and abdominoperineal excision for low rectal cancer.
  
  
  METHODS
  Data were collected prospectively on 62 patients undergoing low anterior resection (32) and abdominoperineal excision (30) for low rectal adenocarcinoma within 6 cm of the anal verge. Patients with metastatic disease were excluded. Quality of life was assessed by the use of the European Organization for Research and Treatment of Cancer's QLQ-C30 and QLQ-CR38 modules and Coloplast stoma quality-of-life questionnaire. Bowel function was assessed by using the St Mark's bowel function questionnaire. Quality of life in patients who had low anterior resection was compared with those who had abdominoperineal excision both preoperatively and 1 year after surgery.
  
  
  METHODS
  This study was conducted at 3 centers in the United Kingdom and 1 center in Europe.
  
  
  METHODS
  Included were consecutive patients with rectal cancer within 6 cm of the anal verge, all of whom provided written consent for participation.
  
  
  METHODS
  Mann-Whitney U test comparisons of QLQ-C30 and QLQ-CR38 module scores for patients undergoing low anterior resection and abdominoperineal excision were the main outcomes measured.
  
  
  RESULTS
  Patients undergoing low anterior resection were younger (median age, 59.5 vs 67, p = 0.03) with higher tumors (4 vs 3, p < 0.001) and less likely to receive neoadjuvant therapy (p = 0.02). At 1 year postoperatively, global quality-of-life ratings were comparable, but patients undergoing abdominoperineal excision reported better cognitive (100 vs 83, p = 0.018) and social (100 vs 67, p = 0.012) function, and less symptomatology with respect to pain (0 vs 17, p = 0.027), sleep disturbance (0 vs 33, p = 0.013), diarrhea (0 vs 33, p = 0.017), and constipation (p = 0.021). Patients undergoing low anterior resection reported better sexual function (33 vs 0, p = 0.006), but 72% experienced a degree of fecal incontinence.
  
  
  CONCLUSIONS
  This study was limited by its relatively small sample size.
  
  
  CONCLUSIONS
  Abdominoperineal excision should not be regarded as an operation that is inferior to low anterior resection in the management of low rectal cancer on the basis of quality of life alone.
authors.affiliation: Pelican Cancer Foundation, Basingstoke, UK. pd_how@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: How
authors.forename: S
authors.initials: S
authors.lastname: Stelzner
authors.forename: G
authors.initials: G
authors.lastname: Branagan
authors.forename: K
authors.initials: K
authors.lastname: Bundy
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.forename: R J
authors.initials: RJ
authors.lastname: Heald
authors.forename: B
authors.initials: B
authors.lastname: Moran
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003113:Colonoscopy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011351:Proctoscopy; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome