Abstract
Background: The aim of the review is to assess the quality of life of patients with rectal cancer who underwent different surgical approaches such as abdominoperineal resection of the rectum (APR) and sphincter saving operations SSO (low anterior resection - LAR, intersphincteric resection - ISR) based on modern literature data.
Methods: The studies considering functional outcomes after APR and SSO and published over the last decade were randomly reviewed.
Results: The social, emotional, physical and cognitive abilities are impacted equally by both methods. The rate of specific functional outcomes after APR or SSO can be different depending on the anatomical features, stage of the disease, localization of the tumor in the rectum. The rate of sexual impairment fluctuates and tends to worsen in the patients after APR in some studies whereas SSO is quite often followed by LARS which significantly impaired QOL in 20 - 75% of the patients. In addition, APR impacted body image which causes dissatisfaction in 15 - 80% of patients and can be worse when the cultural issues are considered. Radiation therapy and chemotherapy may exacerbate various functional problems such as urogenital and sexual impairments of the patients after both surgical approaches. In addition, the experience of cancer by patients may temporarily mitigate the perception of the functional consequences with the first year after treatment. The patients must be informed about the consequences of SSO such as LARS and about that than those who would have a permanent stoma after APR may be surprised later on that their preoperative anxieties over the colostomy would not be turned into reality after treatment.
Conclusion: The long-term QOL of the patients with permanent stoma is equivalent to those with preserving anus for low rectal cancer.
Keywords: Rectal Cancer; Abdominoperineal Resection; Sphincter Saving Operations; Functional Outcomes; Quality of Life
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