Postoperative Function and Quality of Life of Patients With Low Rectal Cancer: A Multidimensional Comparison Between Low Anterior Resection and Abdominoperineal Resection

BACKGROUND: The choice between low anterior resection (LAR) and abdominoperineal resection (APR) for low rectal cancer involves complex trade-offs between sphincter preservation and functional outcomes. OBJECTIVE: This study aimed to compare overall quality of life (QoL), colorectal-specific symptoms, and functional outcomes between LAR and APR at ≥ 12 months post-surgery and to identify influencing factors. METHODS: This single-center retrospective cohort study included patients who underwent LAR or APR for low rectal cancer (≤ 5 cm from the anal verge) between January 2019 and December 2023. Patients completed validated questionnaires 12-60 months post-surgery. Inverse probability of treatment weighting was employed to adjust for baseline imbalances. RESULTS: Out of 168 eligible patients, 142 (84.5%) completed assessments (LAR n = 78, APR n = 64). After adjustment, the mean global health status was 68.3 ± 18.5 for LAR versus 71.2 ± 16.8 for APR (adjusted mean difference -2.9, p = 0.302). Major low-anterior resection syndrome affected 44.9% of LAR patients, whereas 31.3% of APR patients reported poor stoma-related QoL. Sexual dysfunction was prevalent in both groups. Neoadjuvant chemoradiotherapy and tumor distance ≤ 3 cm predicted major LARS. LARS severity did not perfectly align with QoL impairment; 20.0% of patients with minor LARS reported poor QoL, whereas 22.9% with major LARS maintained good QoL. CONCLUSIONS: No clinically meaningful difference in overall QoL was observed between LAR and APR at long-term follow-up. However, procedure-specific challenges exist; major LARS affects nearly half of LAR patients, and one-third of APR patients report poor stoma-related QoL. These findings support individualized surgical decision-making based on patient priorities and risk factors.