A new study published in the Journal of Gastrointestinal Surgery revealed differences in long-term outcomes — namely, physical activity, quality of life (QoL), and health status — between survivors of rectal cancer who underwent low anterior resection (LAR) and those who underwent abdominoperineal resection (APR).1 LAR is a sphincter-preserving operation.

A total of 905 survivors of rectal cancer who underwent treatment with either LAR or APR between 2000 and 2009 were included in the study; 632 participants underwent LAR and 273 APR. Starting in 2010, participants were asked to complete questionnaires to assess QoL, health status, and physical activity as it related to surgical procedure.

Participant characteristics were similar between surgical treatment groups. Radiotherapy treatment, however, was more common in the APR group compared with the LAR group (94% vs 75%, respectively, P < .001).

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Participants reported no differences in physical activity between treatment groups. As for QoL participants who underwent APR reported worse physical and role functioning and worse body image, yet fewer constipation and gastrointestinal issues. When participants who underwent APR were compared to those who underwent LAR with a permanent ostomy, these differences in QoL measures disappeared.

The study authors noted several limitations, including survivorship bias and lack of data on physical activity level and QOL at baseline; also the presence of an ostomy may have been a confounding factor.

“Despite these limitations, this study is a large population based study with high response rates (75%),” the study authors wrote. “Therefore, extrapolating these results to the larger populations of rectal cancer survivors seems justified.”


1.      Koëter T, Bonhof CS, Schoormans D, et al. Long-term outcomes after surgery involving the pelvic floor in rectal cancer: physical activity, quality of life, and health status [published online October 29, 2018]. J Gastrointest Surg. doi: 10.1007/s11605-018-4014-4