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short form general health survey of 36 questions (SF-36); a cancer-specific instrument, the European or-
ganization for research and treatment of cancer quality of life questionnaire EORTC QLQ-C30 version
3.0; and the two colorectal cancer-specific instruments, the EORTC colorectal quality of life questionnaire
QLQ-CR38 and QLQ-CR29 [8-12] . The SF-36 questionnaire is a generic health survey that can be applied
across different diseases and treatment groups. It seeks to capture the physical, mental, and social health of
patients through 36 questions. The EORTC quality of life questionnaires were developed by a broad range
of professionals involved in the care of cancer to provide a multidimensional assessment of health for the
cancer patient that could be self-administered and applicable across a range of cultural settings. The QLQ-
C30 questionnaire consists of 30 items divided into functional scales of physical, emotional, cognitive, and
social function; a symptom scale, and a global health scale. The symptom scales include assessments on
pain, fatigue, appetite, insomnia, and emesis. The EORTC QLQ-CR38 and QLQ-CR29 colorectal cancer
specific questionnaire addresses issues specific to colorectal cancer patients related to gender, urinary and
fecal incontinence, and problems associated with having a stoma.

The International Prostatic Symptom Score (IPSS) questionnaire measures urinary incontinence and the
International Index of Erectile Function (IIEF) questionnaire measures male sexual dysfunction. IPSS
evaluates urinary issues such as frequency, urgency, nocturia, dysuria, and straining during micturition.
The international consultation on incontinence male/female lower urinary tract symptoms were also used
in some studies [13-16] . The IIEF-5 assesses various aspects of male sexual function including erection, pen-
[17]
etration, ejaculation, desire, and overall enjoyment . The female sexual function index (FSFI) question-
naire assesses female sexual function, exploring aspects of sexuality including desire, arousal, lubrication,
[18]
satisfaction, pain, and confidence .

LAPAROSCOPIC SURGERY FOR RECTAL CANCER
Laparoscopic surgery is now more utilized than open surgery for colon cancer due to favorable short-
term outcomes related to smaller incisions, including less pain, reduced blood loss, and improved recovery
[19]
time . Furthermore, the use of the laparoscope allows for the projection of a high resolution, magnified,
well-illuminated image of the operative field on multiple monitors. The ten-year outcomes of the COLOR
trial demonstrated equivalent oncologic outcomes between laparoscopic and open surgery for colon can-
[20]
cer in terms of overall survival, disease-free survival, and local recurrence . The purported advantage of
laparoscopic surgery in rectal cancer is better visualization of the deep pelvis and possibly a more accurate
dissection for a total mesorectal excision (TME) than in open surgery. However, laparoscopy in the pelvis
is technically difficult, especially in obese patients with low tumors or narrow pelvises. Maintenance of a
stable camera view and adequate retraction is not often ergonomic, leading to a loss of exposure from sur-
geon and assistant fatigue.

Multiple single center studies have reported quality of life outcomes after laparoscopic surgery for rectal
cancer. In 2006, a single center prospective longitudinal study conducted in the Netherlands examined the
quality of life and sexual function of 51 patients with rectal cancer who underwent either a laparoscopic
[20]
low anterior resection (n = 38, 75%) or laparoscopic abdominoperineal resection (n = 13, 25%) . These
patients were surveyed with three quality of life questionnaires: SF-36, EORTC QLQ-C30, and EORTC
QLQ-CR38. The questionnaires were given preoperatively, and postoperatively upon discharge, and at 3, 6,
and 12 months. The study found that although physical function, social function, vitality, and pain scores
were all worse at the time of discharge compared to baseline scores, all of these measures improved to
baseline by three months and were maintained up to one year postoperatively. Improved mental function
compared to baseline was noted at three months and emotional function improvement was also noted at
one year. Patients also reported an improvement in global quality of life at one year after surgery compared
to their baseline preoperative level. This improvement included alleviation of symptoms of fatigue, pain,
[20]
appetite loss, and diarrhea. There was no comparison group to open in this study .