Quality of life with or without sphincter preservation for rectal cancer

The aim of this investigation was to examine quality of life after surgical treatment for low rectal cancer.

This was a population-based, cross-sectional study on quality of life in patients treated for rectal cancer from 2001 to 2007. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and a single question on the impact of bowel/stoma function on quality of life were sent to patients who had undergone abdominoperineal excision (APE) or low anterior resection (LAR) for rectal cancer with tumours below 10 cm from the anal verge.

Informative answers were obtained from 898 patients (87%). EORTC QLQ-C30 outcomes were very similar for APE and LAR patients in univariate analysis. When adjusted for neoadjuvant radiotherapy and gender, multivariate analysis showed that LAR patients had lower global health status (OR 1.32, 95% CI 1.03; 1.68, P = 0.026) and higher occurrence of constipation (OR 0.47, 95% CI 0.32; 0.69, P < 0.001) and diarrhoea (OR 0.47, 95% CI 0.35; 0.64, P < 0.001). Analysis of the anchor question showed that LAR patients had significantly higher negative impact of bowel function on quality of life in both univariate (OR 3.38, 95% CI 2.62; 4.37, P < 0.001) and multivariate analysis (OR 3.71, 95% CI 2.86; 4.83, P < 0.001) compared with APE.

For patients with low rectal cancer, we found LAR patients had worse global health status and problems with diarrhoea and constipation compared with APE patients.