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Background <p>Colorectal cancer is a major global health concern, with rectal cancer comprising approximately 30% of cases. Surgical management of low rectal cancer includes abdominoperineal resection (APR) and ultra-low anterior resection (ULAR). While APR involves a permanent colostomy, ULAR is associated with bowel dysfunction. Understanding their impact on quality of life (QoL) is essential for optimizing patient outcomes.</p> Aim <p>This study compares the post-surgical quality of life between APR and ULAR in patients with low rectal cancer, focusing on functional outcomes, symptom burden, and psychological well-being.</p> Methods <p>A prospective observational study was conducted at a high-volume tertiary colorectal center from 2020 to 2023, with 1 year follow up. Seventy-seven patients meeting inclusion criteria were enrolled (40 APR, 37 ULAR). Quality of life was assessed using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. Data was analyzed using SPSS v25.0, with a significance threshold of <i>p</i> &lt; 0.05.</p> Results <p>ULAR patients reported better overall functional outcomes (237.6 ± 72.0 vs. 198.7 ± 72.5, <i>p</i> = 0.027) and significantly higher body image scores (<i>p</i> &lt; 0.001). However, they experienced greater bowel dysfunction, including higher fecal incontinence (<i>p</i> &lt; 0.001). APR patients faced stoma-related issues, with increased embarrassment and sexual dysfunction (<i>p</i> &lt; 0.001). Emotional functioning was superior in ULAR patients ( <i>p</i> &lt; 0.001).</p> Conclusion <p>Both surgical approaches impact QoL differently. ULAR preserves body image and emotional well-being but leads to bowel dysfunction, whereas APR eliminates incontinence risks but presents psychosocial challenges. Preoperative counselling is essential to align patient expectations and optimize post-surgical outcomes.</p>

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Beyond Survival: Is Sphincter Preservation Always Better for QoL After Rectal Cancer Surgery?

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Suhail Manzoor,
  • Imad Banday,
  • Rohey Jan,
  • Fazl Q. Parray,
  • Rauf Ahmad Wani,
  • Mubashir Hassan Bhat,
  • Muzamil Rashid,
  • Farhaan Pervaiz Bhat,
  • Meeran Banday

摘要

Background

Colorectal cancer is a major global health concern, with rectal cancer comprising approximately 30% of cases. Surgical management of low rectal cancer includes abdominoperineal resection (APR) and ultra-low anterior resection (ULAR). While APR involves a permanent colostomy, ULAR is associated with bowel dysfunction. Understanding their impact on quality of life (QoL) is essential for optimizing patient outcomes.

Aim

This study compares the post-surgical quality of life between APR and ULAR in patients with low rectal cancer, focusing on functional outcomes, symptom burden, and psychological well-being.

Methods

A prospective observational study was conducted at a high-volume tertiary colorectal center from 2020 to 2023, with 1 year follow up. Seventy-seven patients meeting inclusion criteria were enrolled (40 APR, 37 ULAR). Quality of life was assessed using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. Data was analyzed using SPSS v25.0, with a significance threshold of p < 0.05.

Results

ULAR patients reported better overall functional outcomes (237.6 ± 72.0 vs. 198.7 ± 72.5, p = 0.027) and significantly higher body image scores (p < 0.001). However, they experienced greater bowel dysfunction, including higher fecal incontinence (p < 0.001). APR patients faced stoma-related issues, with increased embarrassment and sexual dysfunction (p < 0.001). Emotional functioning was superior in ULAR patients ( p < 0.001).

Conclusion

Both surgical approaches impact QoL differently. ULAR preserves body image and emotional well-being but leads to bowel dysfunction, whereas APR eliminates incontinence risks but presents psychosocial challenges. Preoperative counselling is essential to align patient expectations and optimize post-surgical outcomes.