Quality of life after rectal surgery. Comparison between continence-preserving resection and abdominoperineal extirpation

Background and Purpose: Sphincter-saving procedures are considered to result in higher quality of life than rectal extirpations with permanent stomata. The objectives of this study were to evaluate the quality of life after abdominoperineal extirpation (APE) and low anterior resection (LAR). Patients and Methods: All patients with LAR and APE between 1998 and 2002 were evaluated. All surviving patients without local recurrence or metastases were evaluated in 2003 using a standardized questionnaire (LAR 16, APE 26). Assessment of continence was performed using a modified Kelly-Holschneider Score, and quality of life was quantified by means of the Gastrointestinal Quality of Life Index (GIQLI) and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Results: There were no significant differences of quality of life between both groups, neither in the EORTC questionnaire (LAR 59 [25-83], APE 61 [25-83]), nor in the GIQLI (LAR 93 [43-118], APE 98 [53-118]). There was a positive correlation between the postoperative continence score and quality of life after LAR (QLC-C30: r = 0.82; GIQLI: r = 0.78). Conclusion: Though quality-of-life data do not differ significantly, sphincter preservation seems to be the more convenient procedure for patients with rectal cancer. Rectal extirpation should be preferred in patients with preoperatively impaired stool continence.