title: Quality of life of patients after low anterior, intersphincteric, and abdominoperineal resection for rectal cancer--a matched-pair analysis.
abstract: OBJECTIVE
  Limits for sphincter preservation in rectal cancer have been expanded under the assumption that patients with a permanent colostomy have worse quality of life (QoL). Incontinence and painful defecation are common problems; therefore, this study compares functional outcome and QoL after sphincter-sparing intersphincteric resection (ISR), low anterior resection (LAR), and abdominoperineal resection (APR) for rectal cancer.
  
  
  METHODS
  From a prospective database, three matched groups of patients after surgery for rectal cancer between 1999 and 2009 were extracted. Median follow-up was 59 months. Of 131 patients receiving a questionnaire, 95 % could be analyzed further. Generic and disease-specific validated QoL (European Organization for Research and Treatment in Cancer QLQ-C30, CR38) and Wexner incontinence score were used.
  
  
  RESULTS
  Global QoL was comparable between the groups. Physical functioning was significantly better after sphincter preservation surgery than APR (p < 0.05). Symptom scores for diarrhea (DIA) and constipation (CON) were higher after sphincter-preserving surgery (ISR: DIA 45.4, CON 20.2; LAR: DIA 34.1, CON 25.2) compared to APR (DIA 16.6, CON 12.0) (p < 0.05 and <0.01, respectively). Disease-specific QoL assessment showed significantly worse QoL regarding to male sexual function after APR (80.8) than after ISR (53.6) (p < 0.005). Regarding defecation, the ISR group showed significantly higher symptom scores than patients after LAR (p < 0.05). Wexner scores were significantly higher after ISR (12.9) than after LAR (9.5) (p < 0.005).
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167 Mannheim, Germany. julia.konanz.@umm.de
authors.forename: Julia
authors.initials: J
authors.lastname: Konanz
authors.forename: Florian
authors.initials: F
authors.lastname: Herrle
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires