Comparison of fecal continence and quality of life between intersphincteric resection and abdominoperineal resection plus perineal colostomy for ultra-low rectal cancer


  • The authors have no conflicts of interest and source of funding. The subject of study had no commercial interest, no financial or material support.
  • Authors contributions: Frédéric Dumont: study concepts, study design, data acquisition and interpretation, manuscript preparation, and editing. Mohammed Ayadi: data acquisition; Diane Goéré: manuscript review; Charles Honoré: manuscript review; Dominique Elias: manuscript review.



The only two procedures for surgical treatment of ultra-low rectal cancer without a permanent abdominal stoma are the intersphincteric resection (ISR) and the abdominoperineal resection (APR) plus a perineal pseudocontinent colostomy (PCC). This study compared functional results and quality of life following these two techniques.


Between January 1995 and December 2011, 36 patients had undergone an ISR (n = 14) or a PPC (n = 22) for very low rectal cancer. The Cleveland Clinica Florida (Wexner) fecal incontinence questionnaire and the EORTC Quality of Life questionnaire QLQ-C30 and CR38 had been administered.


There were no differences in gender, age, the interval between surgery and questionnaire responses, preoperative TNM staging, perioperative treatment, the laparoscopic approach and circumferential margin involvement rate between the groups. The ISR and PPC led to no difference in quality of life (Qol) and continence with a median Wexner score of respectively 11 and 10 (P = 0.403) and a fecal incontinence rate of 58.2% and 41% (P = 0.221). The incontinent patients had experienced worse social functioning and tended to have worse overall health. The patients who had undergone ISR had more defecation problems and evacuation difficulties.


Qol and continence are similar between ISR and PPC. J. Surg. Oncol. 2013 108:225–229. © 2013 Wiley Periodicals, Inc.