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ABSTRACT 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.
Ju et al. (Sat,) studied this question.