Quality of Life Assessment

Sphincter-saving procedures are today considered to be the first choice in the treatment of even very low sited rectal cancer. One may get the impression that an AR should be done whenever possible and at any cost, restricting the use of APR to a small proportion of cases where the lesion actually invades or approaches very closely to the anal canal. The main reason for this has been the conviction that the QoL for patients with a colostomy after APR was poorer than for patients undergoing a sphincter-preserving technique. However, such statements often date from older reports at a time when sanitary and stomather-apeutic standards were poor [15]. Stoma care has improved considerably over the last few decades and the latest generation of stoma appliances provides better patient comfort and a high degree of social convenience. Moreover, patients having a low anterior resection may suffer considerably from symptoms affecting their QoL although the problems are in many respects different from those in stoma patients. Therefore conclusions reached by previous QoL studies comparing stoma with non-stoma patients may no longer be valid. The question is therefore still whether - and if so to what extent - QoL benefits are to be gained by use of ultralow anastomosis compared with APR and a colostomy. What is the prevalence of physical, psychological, social and sexual dysfunction among patients whose sphincters have been sacrificed compared with those in whom sphincters were preserved?

The results of a careful review of the literature on the subject have recently been published [21]. The Authors identified 25 potential studies. Eight of these - all non-randomised and representing 620 participants - met the inclusion criteria. Four trials found that patients having an APR did not have poorer QoL measures than patients with AR. One study found that the colostomy affected the patients' QoL only slightly. Three studies found that patients with an APR had significantly poorer QoL than after AR. Due to heterogeneity, meta-analysis of the included studies was not considered justified. The authors concluded that the results from the review did not allow firm conclusions as to the question of whether the QoL of patients after AR is superior to that of people after APR and suggested that larger, better designed and executed prospective studies are needed to answer this question.

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