Quality of life and sexual function following surgery for rectal cancer.

The last 20 years have seen enormous strides forward in the treatment of rectal cancer with the development of improved surgical technique, tumour staging, histopathological audit and multidisciplinary team (MDT) management with emphasis on improving survival and reducing local recurrence rates. However, each rectal cancer discussed at the MDT meeting involves an individual patient. The quality of life for each patient must be taken into account when making treatment decisions, which sometimes may not fit with 'standard' treatment guidelines as the individual patient does not have a 'standard' tumour. For one patient with a tumour 5 cm above the anal verge, a low anterior resection may maintain quality of life with no incontinence and preservation of urinary and sexual function. For another with a tumour at the same level, preoperative chemo-radiotherapy may exacerbate mild incontinence and a low resection may result in a 'perineal stoma'. A decision to perform an abdomino-perineal excision (APE) must not be considered a failure of surgical treatment or be seen as a suboptimal centre by having a high APE rate. On the contrary, APE rates should represent sub-specialization and patient selection. Indeed, good function from a permanent stoma may be better than bad function from a poorly functioning coloanal pouch. Having improved tumour staging, surgical technique, oncological treatment and histopathological assessment, quality of life must not be forgotten. Both quality and quantity of life are important to all patients.