title: Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient's quality of life?
abstract: OBJECTIVE
  Sphincter-saving operation with coloanal anastomosis (CAA) has become an established option for very low rectal cancer, but few studies have compared its functional results and quality of life (QoL) with abdominoperineal resection (APR) showing controversial results.
  
  
  METHODS
  Patients treated for low rectal cancer with APR or CAA, disease-free after a median follow-up period of 26.5 (8-84) and 52.5 (12-156) months, respectively, were retrospectively reviewed. General and disease-specific changes in QoL and severity of disease were evaluated by Karnofsky scale, EORTC-C30, EORTC-CR38, SF-36, PGWBI, FIQL, PAC-QoL, ICIQ-SF, Stoma-QoL, AMS, Wexner's score and obstructed defecation syndrome (ODS) score.
  
  
  RESULTS
  Twenty-six APR patients and 34 CAA patients entered the study. Karnofsky score did not show significant differences. The median Stoma-QoL was 58.2 (45-76.6), indicating a good stoma function in 95% of patients. EORTC-C30, CR38, PGWBI and SF-36 questionnaires did not show significant differences between the two groups except for sexual function (better after CAA, p = 0.01). Eleven patients after APR and eight after CAA had urinary incontinence, and its severity did not differ significantly. Eighteen of 21 CAA patients complained of faecal incontinence [AMS, 80 (15-120); Wexner, 13 (2-19)] with an impact on their QoL [FIQL: lifestyle, 1.75 (0-4); coping/behaviour, 1.3 (0-3.5); depression, 2.1 (0-5.2); embarrassment, 2 (0-4.6)] and 11 complained of obstructed defecation [7.5 (3-16)] with significant consequences on QoL [PAC-QoL, 30.4 (19.2-80.3)].
  
  
  CONCLUSIONS
  QoL in patients with permanent stoma and in those after CAA did not differ significantly. APR patients had worse sexual function, while most CAA patients had faecal incontinence and sometime obstructed defecation, with important impact on their QoL.
authors.affiliation: Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Digennaro
authors.forename: Mirna
authors.initials: M
authors.lastname: Tondo
authors.forename: Filippa
authors.initials: F
authors.lastname: Cuccia
authors.forename: Ivana
authors.initials: I
authors.lastname: Giannini
authors.forename: Francesco
authors.initials: F
authors.lastname: Pezzolla
authors.forename: Marcella
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Dario
authors.initials: D
authors.lastname: Scala
authors.forename: Giovanni
authors.initials: G
authors.lastname: Romano
authors.forename: Donato F
authors.initials: DF
authors.lastname: Altomare
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D010820:Physicians; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology