CLINICS 2011;66(6):1035-1040 CLINICAL SCIENCE DOI:10.1590/S1807-59322011000600019 Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer Luiz Felipe de Campos-Lobato, Patricia Cristina Alves–Ferreira, Ian C. Lavery, Ravi P Kiran Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. PURPOSE: Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection. METHODS: Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of- life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life. RESULTS: The query returned 153 patients (abdominoperineal resection = 68, low anterior resection = 85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 ¡ 12 vs. 54 ¡ 12, p , 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p = 0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery. CONCLUSION: Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection. KEYWORDS: Rectal cancer; Quality of life; Abdominoperineal resection; Low anterior resection. de Campos-Lobato LF, Alves–Ferreira PC, Lavery IC, Kiran RP. Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer. Clinics. 2011;66(6):1035-1040. Received for publication on March 7, 2011; First review completed on March 16, 2011; Accepted for publication on March 16, 2011 E-mail: kiranp@ccf.org Tel.: 44 118 216 445-9715 INTRODUCTION An increasing number of people are diagnosed with rectal cancer in the United States each year, with approximately 50,000 new cases expected for the year 2010.1 The past two decades have been marked by advances in rectal cancer treatment, particularly the widespread adoption of total mesorectal excision2-4 and use of neoadjuvant chemoradia- tion,5,6 both of which have improved local control, whereas modern adjuvant chemotherapy regimens have increased overall and disease-free survival.7-9 Therefore, gaining a better understanding of the quality of life (QOL) of rectal cancer survivors has become a matter of paramount importance. The surgical treatment options for patients with low rectal cancer (i.e., less than 5 cm from the anal verge) include low anterior resection (LAR) or abdominoperineal resection (APR).9-11 An APR is the procedure of choice when a distal margin of clearance cannot be obtained or the sphincter complex is invaded by the tumor, whereas LAR is indicated for all other low rectal cancers10,12,13 or LAR is technically feasible but may be associated with poor functional outcomes because of sphincter dysfunction. It is a common perception that issues related to body image and a permanent stoma after APR have a negative impact on QOL; consequently, this procedure is avoided whenever possible.14 Recent studies have shown, however, that specific problems associated with a low anastomosis may similarly affect QOL of patients with low rectal cancer who undergo LAR.15,16 Therefore, the aim of this study is to compare the overall QOL in low rectal cancer patients undergoing either APR or LAR. Copyright 2011 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. PATIENTS AND METHODS This study was approved by the Cleveland Clinic Institutional Review Board. A single center, prospectively 1035