Quality of life after laparoscopic surgery for very low rectal cancer: A sub‐analysis of the ultimate trial

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AIM: Laparoscopic low anterior resection is widely used for treating rectal cancer; however, postoperative complications frequently result in a marked deterioration in the patients' quality of life (QOL). This study aimed to investigate the trajectory of QOL recovery and identify the risk factors affecting QOL in patients undergoing laparoscopic surgery for very low rectal cancer. METHOD: This prospective, multi-institutional, single-arm, phase-II trial examined the outcomes of laparoscopic surgery in patients with very low rectal cancer (<5 cm from the anus). The Short Form 36 Health Survey questionnaire was used to assess QOL preoperatively and at 3 and 6 months and 1, 2 and 3 years postoperatively. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for impaired QOL. RESULTS: Overall, 259 patients were analysed, of whom 63% underwent intersphincteric resection. The physical component summary (PCS) score declined postoperatively but gradually recovered, whereas the mental component summary score showed sustained improvement. The role component summary (RCS) score significantly declined at 3 months but improved over time. Multivariate analysis identified stage III cancer as a risk factor for prolonged PCS decline (p = 0.0084) and Wexner score ≥9 at 1 year after surgery as a predictor of lower RCS score (p = 0.0116). CONCLUSION: QOL after laparoscopic surgery for low-lying rectal cancer is generally acceptable. Patients with stage III cancer experience prolonged physical challenges, whereas those with bowel dysfunction struggle with role/social domains of QOL. Targeted interventions should be implemented to address these issues.

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