ObjectiveTo evaluate the quality of life (QoL) in patients undergoing anterior resection (AR) or abdominoperineal extirpation (APE) for rectal cancer in a sample of patients recruited from a field trial.
Summary Background DataAbdominoperineal resection has been reported to put patients at higher risk of disruption to QoL than sphincter-preserving surgery.
MethodsFifty patients treated with AR and 23 patients treated with APE were prospectively followed up. All patients were treated in curative attempt and were disease-free throughout the study. QoL was assessed before surgery and 6 to 9 and 12 to 15 months after surgery.
ResultsMultivariate analysis of variance and subsequent post hoc comparisons revealed a main effect for time (role function, emotional function, body image, future perspective, and micturition-related problems) and group in favor of APE (sleeping problems, constipation, diarrhea), and a time-by-group interaction (role function). No significant results were obtained for the remaining scores, but patients undergoing APE consistently had more favorable QoL scores than those undergoing AR. Multivariate analysis and post hoc comparisons revealed a particularly poor QoL for patients undergoing low AR. They had a significantly lower total QoL, role function, social function, body image, and future perspective, and more gastrointestinal and defecation-related symptoms than patients undergoing high AR.
ConclusionPatients undergoing APE do not have a poorer QoL than patients undergoing AR. Patients undergoing low AR have a lower QoL than those undergoing APE. Attention should be paid to QoL concerns expressed by patients undergoing low AR.It is the state of the art that whenever feasible, rectal cancer should be treated with sphincter-preserving surgical techniques. A vast body of literature suggests that patients who have a colostomy have a worse quality of life (QoL) than those without a stoma.1-11 However, any interpretation of the seemingly unequivocal results on this issue must take into account the major drawbacks of many of the investigations focusing on QoL aspects in patients with rectal cancer. A main problem is related to general disagreement among QoL researchers as to which method and instrument are most appropriate for accrual of QoL information. An abundance of techniques can be used to collect QoL data, including structured, semistructured, or nonstructured interviews, standardized and nonstandardized questionnaires, and ad hoc questions. This incompatibility in data accrual has resulted in a broad range of inventories used to assess QoL in patients with colorectal cancer and has also contributed to a body of inconsistent findings. In an excellent survey on QoL aspects in patients treated for cancer of the rectum, Camilleri-Brennan and Steele 10 described the current data situation in the field and concluded that "the methodological shortcomings of previous work must be rectified if quality of life studies are to have relevance inpatient management." Of 54 papers on the subject published ...