Quality of life after rectal cancer surgery de Campos-Lobato LF et al. Table 4 - Overall quality of life. SF-36 component APR 68 (44%) LAR 85 (56%) CLINICS 2011;66(6):1035-1040 Nonadjusted analysis Adjusted analysisb Difference in meansa (95% CI) p Value Difference in meansa (95% CI) p Value Physical Baseline 6 mo 12 mo 36 mo Mental 6 mo 12 mo 36 mo Baseline Physical 6 mo 12 mo 36 mo Mental 6 mo 12 mo 36 mo Values expressed as means and standard deviation. SF-36: Short form. A complete quality of life follow-up could not be obtained for a portion of patients involved in this study. APR: Abdominoperienal resection, LAR: Low anterior resection, CI: Confidence interval. a Calculated by subtracting the mean SF-36 score of APR from LAR at the time of the assessment. b Analysis adjusted for age at surgery, body mass index, pathologic stage, use of radiation therapy, and 30 d postoperative complications. was obtained in the preoperative period. A further corroboration of this premise is the finding that the mSF- 36 score was lower for APR rather than LAR patients, although the pSF-36 score was similar between groups. In contrast, the hope that LAR carries, of avoiding a permanent stoma, may lead to patients being more hopeful and positive prior to surgery, as depicted by the higher baseline mSF-36 score. Thus LAR patients may carry a higher expectation for surgical outcomes than APR patients. However, LAR may be associated with multiple side effects as discussed, which may affect QOL after surgery, regardless of how well patients have been counseled about these factors by their surgeons. As a result, when LAR patients are in the midst of having to adapt to their new lifestyle governed by bowel function, the potential for frustration can be great, because it may contradict these expectations. On the other hand, patients undergoing APR typically have a lower preopera- tive expectation, and, following the realization that they can lead a fairly normal life despite coping with a stoma, they may become more satisfied on average, postoperatively. This is further supported by the fact that, in our study, the major changes in overall QOL happened in the mSF-36, with LAR patients decreasing their mSF-36 scores throughout the follow-up period, whereas that of APR patients increased. The confidence intervals for mean differences between the groups presented in Tables 4 and 5 have lower and upper Table 5 - Changes in overall quality of life. SF-36 component APR 68 (44%) LAR 85 (56%) Nonadjusted analysis Adjusted analysisb p - Value Difference in meansa (95% CI) p Value Values expressed as means and standard deviation. SF-36: Short form, APR: Abdominoperienal resection, LAR: Low anterior resection, CI: Confidence interval. A complete quality of life (QOL) follow-up could not be obtained for a portion of patients involved in this study. Changes in QOL calculated by subtracting the mean SF-36 score from the baseline mean SF-36 score. a Calculated by subtracting the changes in SF-36 score of LAR from change in SF-36 score of APR patients. b Analysis adjusted for age at surgery, pathologic stage, use of radiation therapy,and 30 d postoperative complications. 44.8 ¡ 9.2 N = 68 43.6 ¡ 10.0 N = 25 46.3 ¡ 10.6 N = 30 45.2 ¡ 11.3 N = 25 43.6 ¡ 10.1 N = 68 46.4 ¡ 10.4 N = 25 48.0 ¡ 9.8 N = 30 47.4 ¡ 10.0 N = 25 47.7 ¡ 8.8 N = 85 46.14 ¡ 8.3 N = 48 48.3 ¡ 7.7 N = 55 50.5 ¡ 9.2 N = 29 48.5 ¡ 9.7 N = 85 46.3 ¡ 9.0 N = 48 47.6 ¡ 9.0 N = 55 49.9 ¡ 8.1 N = 29 +2.9 (+0.03 to +5.85) +2.5 (-1.8 to +6.8) +2.0 (-1.9 to +5.9) +5.3 (-0.2 to +10.8) +5.0 (+1.8 to +8.2) -0.1 (-4.6 to +4.5) -0.5 (-4.6 to +3.7) +2.5 (-2.4 to +7.3) 21.7 ¡ 11.6 N = 25 1.0 ¡ 8.7 N = 30 22.2 ¡ 11.9 N = 25 0.6 ¡ 10.0 N = 25 4.4 ¡ 11.0 N = 30 2.5 ¡ 11.2 N = 25 22.0 ¡ 9.5 N = 48 21.12 ¡ 9.7 N = 55 20.6 ¡ 9.5 N = 29 22.5 ¡ 11.4 N = 48 22.5 ¡ 10.3 N = 55 21.5 ¡ 11.1 N = 29 Difference in meansa (95% CI) 20.4 (25.4 to +4.6) 22.2 (26.4 to +2.1) +1.7 (24.1 to +7.4) 23.1 (28.4 to +2.2) 26.9 (211.7 to +2.2) 24.0 (210.0 to +2.0) 1038 0.05 0.26 0.33 0.06 0.003 0.98 0.83 0.32 0.88 0.32 0.57 0.26 0.005 0.2 +1.7 (-1.6 to +5.0) +1.6 (-2.8 to +6.1) +1.3 (-3.1 to +5.6) +6.6 (-1.0 to +12.2) +5.6 (+1.9 to +9.3) -0.3 (-5.3 to +4.8) +0.14 (-4.5 to +4.8) +2.8 (-2.4 to +7.9) +0.4 (25.1 to +5.9) 21.3 (25.9 to +3.3) +3.2 (23.1 to +9.4) 23.1 (29.1 to +2.9) 27.9 (213.1 to +2.6) 24.2 (210.7 to +2.3) 0.32 0.48 0.56 0.22 0.003 0.92 0.95 0.29 0.89 0.58 0.33 0.31 0.004 0.21