ADAM12 is A Potential Therapeutic Target Regulated by Hypomethylation in Triple-Negative Breast Cancer.

Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype and currently lacks any effective targeted therapy. Since epigenetic alterations are a common event in TNBC, DNA methylation profiling can be useful for identifying potential biomarkers and therapeutic targets. Here, genome-wide DNA methylation from eight TNBC and six non-neoplastic tissues was analysed using Illumina Human Methylation 450K BeadChip. Results were validated by pyrosequencing in an independent cohort of 50 TNBC and 24 non-neoplastic samples, where protein expression was also assessed by immunohistochemistry. The functional role of disintegrin and metalloproteinase domain-containing protein 12(ADAM12) in TNBC cell proliferation, migration and drug response was analysed by gene expression silencing with short hairpin RNA. Three genes (Von Willenbrand factor C and Epidermal Growth Factor domain-containing protein (VWCE), tetraspanin-9 (TSPAN9) and ADAM12) were found to be exclusively hypomethylated in TNBC. Furthermore, ADAM12 hypomethylation was associated with a worse outcome in TNBC tissues and was also found in adjacent-to-tumour tissue and, preliminarily, in plasma from TNBC patients. In addition, ADAM12 silencing decreased TNBC cell proliferation and migration and improved doxorubicin sensitivity in TNBC cells. Our results indicate that ADAM12 is a potential therapeutic target and its hypomethylation could be a poor outcome biomarker in TNBC.

Influence of rescrubbing before laparotomy closure on abdominal wound infection after colorectal cancer surgery: results of a multicenter randomized clinical trial.

OBJECTIVE: To test the hypothesis that strict asepsis in closing wounds following laparotomy reduces the risk for surgical wound infection in elective colorectal cancer surgery. DESIGN: Multicenter randomized clinical trial conducted from June 1, 2009, through June 1, 2010. SETTINGS: Colorectal surgery units of 9 Spanish hospitals. PATIENTS: A total of 969 patients who underwent elective colorectal cancer surgery were eligible for randomization. In closing the laparotomy wound, the patients were randomized to 2 groups: conventional (n=516) and new operation (n=453). In the conventional group, a new set of instruments was used, surgical staff changed their gloves, and the surgical drapes surrounding the laparotomy were covered by a new set of drapes. The new operation group involved removing all drapes, the surgical staff scrubbed again, and a new set of drapes and instruments was used. MAIN OUTCOME MEASURES: Incisional (superficial and deep) surgical site infection 30 days after the operation and risk factors for postoperative wound infections. RESULTS: A total of 146 incisional surgical site infections (15.1%) were diagnosed. Of these, 96 (9.9%) were superficial and 50 (5.1%) were deep infections. On an intent-to-treat basis, significant differences were found between both groups (66 [12.8%] in the conventional group vs 80 [17.7%] in the new operation group [P=.04]). CONCLUSION: This study does not support the use of rescrubbing to reduce the incidence of incisional surgical site infection. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN19463413

Prevalence of symptoms of knee or hip joints in older adults from the general population.

BACKGROUND AND AIMS: The prevalence of knee and hip symptoms varies from study to study, or is unknown. The goals of this study were to determine the prevalence of these symptoms, of diagnosed osteoarthritis and the use of prostheses, by age and gender, in a sample of the general older population. METHODS: We mailed a questionnaire to 11,002 people aged 60 to 90 years who were selected by stratified random sampling. The questionnaire included questions on pain, functional limitations, diagnosed osteoarthritis, previous operations on either or both joints, and sociodemographic data. Descriptive statistics were performed. RESULTS: From 10,150 people who fulfilled the selection criteria, 74.6% answered the questionnaire. Up to 49.2% of the subjects reported pain in either knee or hip or both, with pain in the knee reported more frequently (38.3%) than the hip (23.8%). Functional limitations were present in 51.6% of respondents, with 42.5% having limitations in the knees and 27.7% in the hips. The symptoms increased with age and were more prevalent in women. About 6.6% of respondents reported that they had already had prosthesis implant (hip 3.9%; knee 2.6%). The presence of a hip prosthesis was slightly lower in women than in men and more women had a knee prosthesis. Physicians had already diagnosed osteoarthritis in 38.5% of the sample, 19.4% of the hip and 31% of the knee. CONCLUSIONS: The prevalence of pain symptoms is relatively high among older people, more often in the knee and, in both joints, more often in women, but the rate of prosthetic surgeries was low, which means that additional studies are necessary to gain insight into the healthcare needs of the population.

[Introduction of laparoscopy in the treatment of rectal cancer in a coloproctology unit]. / Introducción de la laparoscopia en el tratamiento del cáncer de recto en una unidad de coloproctología.

INTRODUCTION: The application of the laparoscopic approach to the treatment of rectal cancer is controversial. The aim of the present study was to evaluate whether the introduction of this technique in a coloproctology unit modified the quality of rectal cancer surgery. MATERIAL AND METHOD: We performed a prospective, nonrandomized study of all patients with rectal cancer who underwent surgery with curative intent in 2003 and 2004. Patients with stage T4 tumors were excluded. Of the 59 patients included, 33 underwent laparoscopic surgery and 26 underwent open surgery. A series of intraoperative and postoperative variables and characteristics of the surgical specimen were compared between the two groups. RESULTS: No differences were found between the two groups in the type of intervention performed or in the rate of sphincter preservation. Overall morbidity was 39% in the laparoscopic group and 34% in the open surgery group (NS). Anastomotic dehiscence was 9.5% and 5.8% respectively (NS). The length of hospital stay was similar in both groups. The distal margin was adequate in all patients. The circumferential resection margin was positive (< 1 mm) in 10.7% of patients in the laparoscopic group who underwent total mesorectal excision and in 13.6% of those in the open surgery group (NS). The mean number of isolated nodes was 12.5 in the laparoscopic group and 15.5 in the open surgery group (NS). CONCLUSION: The introduction of the laparoscopic approach in the treatment of rectal cancer in our unit has not lowered surgical quality, as measured by clinical and histopathological variables.

[Incidence of psychiatric disorders in patients with fecal incontinence]. / Incidencia de problemas psiquiátricos en pacientes con incontinencia fecal.

OBJECTIVE: To evaluate the presence of psychiatric alterations in patients with fecal incontinence. PATIENTS AND METHOD: Eighty consecutive patients (67 women) with fecal incontinence were evaluated. All the patients completed the the specific GHQ-28 questionnaire to evaluate psychiatric symptoms. The questionnaire had previously been validated in the Spanish language. A score equal to or higher than 6 points was considered to indicate pathology. Incontinence was evaluated by the Cleveland Clinic Florida-Fecal Incontinence severity score (range 0 - 20). Psychiatric antecedents prior to fecal incontinence were recorded. RESULTS: Thirty-two patients (40%) had pathological scores on the GHQ-28 questionnaire (mean 13.59, range: 7-26). The mean Cleveland score was 11.52 (range: 2-20). Patients with pathological GHQ-28 scores had higher fecal incontinence scores (14.28 vs 9.68; p < 0.0001). A significant lineal correlation was found between GHQ-28 scores and the severity of fecal incontinence (p < 0.0001). Psychiatric antecedents were found in 17 patients (21.3%). In these patients no correlation was found between GHQ-28 score and the severity of incontinence. In the subgroup of patients without psychiatric antecedents this correlation was maintained (p < 0.003). Of these, 20 (31.7%) had pathologic scores on the GHQ-28, and the mean incontinence severity score was significantly higher than that of those with a normal GHQ-28 score (13.15 vs. 9.25; p < 0.004). CONCLUSIONS: The prevalence of psychiatric alterations is high in patients with fecal incontinence and is correlated with its severity. Patients with psychiatric antecedents can bias evaluation of the association between psychiatric alterations and the severity of fecal incontinence.

Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature.

PURPOSE: The aim of this prospective study was to compare the results of stapled hemorrhoidopexy with those of conventional diathermy excision for controlling symptoms in patients with fourth-degree hemorrhoids. METHODS: Thirty-one patients with symptomatic, prolapsed irreducible piles were randomized to either stapled hemorrhoidopexy (n = 15) or diathermy excision (n = 16). The primary outcome measure was the control of hemorrhoidal symptoms one year after operation. RESULTS: The two procedures were comparable in terms of pain relief and disappearance of bleeding. Recurrent prolapse starting from the fourth month after operation was confirmed in 8 of 15 patients in the stapled group and in none in the diathermy excision group: two-tailed Fisher's exact test P = 0.002, RR 0.33, 95 percent confidence interval 0.19-0.59). Five of these patients responded well to a later conventional diathermy hemorrhoidectomy. Persistence of itching was reported in six patients in the stapled group and in one of the diathermy excision group (P = 0.03). On the other hand, six patients in the stapled group and none in the diathermy excision group experienced tenesmus (P = 0.007). CONCLUSIONS: Stapled hemorrhoidopexy was not effective as a definitive cure for the symptoms of prolapse and itching in patients with fourth-degree hemorrhoids. Moreover, stapled hemorrhoidopexy induced the appearance of a new symptom, tenesmus, in 40 percent of the patients. Therefore conventional diathermy hemorrhoidectomy should continue to be recommended in patients with symptomatic, prolapsed, irreducible piles.

[Fissure-in-ano. Alterations in continence and quality of life during disease and at six months after lateral subcutaneous internal sphincterotomy]. / Fisura de ano. Alteraciones de la continencia y de la calidad de vida durante la enfermedad y a los 6 meses de la esfinterotomía lateral interna subcutánea.

OBJECTIVE: To prospectively evaluate alterations in continence and quality of life produced by lateral internal sphincterotomy with each patient acting as his or her own control. PATIENTS AND METHOD: Quality of life (SF-36 questionnaire) and fecal incontinence (Cleveland Clinic Florida-Fecal Incontinence [CCF-FI] questionnaire) were evaluated before and 6 months after lateral internal sphincterotomy was performed in 113 consecutive patients diagnosed with chronic anal fissure. RESULTS: Four patients were excluded because of their inability to complete the SF-36 questionnaire without help. Of the 109 remaining patients, there was persistence or relapse of anal fissure in six (5.5%). One patient refused to complete the quality of life questionnaire again and was excluded from the study. Of the 108 patients who completed the study, the median (interquartile range) score in the CCF-FI scale increased from 0.00 (3) before the intervention to 1(4) in the postoperative period (p = 0.001). Quality of life significantly improved after the operation, since the scores of the following scales increased: physical functioning (p = 0,005), role limitations-physical (p = 0.006), bodily pain (p < 0.001), vitality (p = 0.008), social functioning (p = 0.022) and mental health (p < 0.001). No statistically significant differences were found in general health perception or in role limitations-emotional. CONCLUSION: Despite deterioration in continence, sphincterotomy improves quality of life in patients with anal fissure.

Incidencia de problemas psiquiátricos en pacientes con incontinencia fecal / Incidence of psychiatric disorders in patients with fecal incontinence

Objetivo. Valorar la presencia de alteraciones psiquiátricas en las personas con incontinencia fecal. Pacientes y método. Ochenta pacientes (67 mujeres) diagnosticados de incontinencia fecal. Todos cumplimentaron el cuestionario específico GHQ-28, validado en lengua española para evaluación de alteraciones psiquiátricas; es patológica una puntuación igual o superior a 6. La gravedad de la incontinencia se evaluó con la escala de la Cleveland Clinic-Florida (rango, 0-20). Se recogieron los antecedentes psiquiátricos anteriores a su incontinencia fecal. Resultados. Treinta y dos pacientes (40%) presentaban puntuaciones patológicas en el cuestionario GHQ-28 (media, 13,59; rango, 7-26). La media de gravedad de la incontinencia ha sido de 11,52 puntos (rango, 2-20). Los pacientes con puntuaciones patológicas en el cuestionario GHQ-28 tenían puntuaciones mayores en la escala de gravedad de incontinencia (14,28 frente a 9,68; p < 0,0001). Se ha encontrado una correlación lineal significativa (p < 0,0001) entre las puntuaciones del GHQ-28 y la gravedad de la incontinencia fecal. Presentaban antecedentes psiquiátricos 17 pacientes (21,3%) en los que se pierde la correlación entre la puntuación del GHQ-28 y la gravedad de la incontinencia. En el subgrupo sin antecedentes se mantiene esta correlación (p < 0,003). De ellos, 20 (31,7%) presentaban puntuaciones patológicas del GHQ-28, con una media de gravedad de la incontinencia significativamente superior a aquellos con puntuación normal (13,15 frente a 9,25; p < 0,004). Conclusiones. La presencia de alteraciones psiquiátricas es alta en los pacientes con incontinencia, y tiene correlación con la gravedad de la incontinencia. Los antecedentes psiquiátricos pueden sesgar la valoración de los pacientes con incontinencia fecal (AU)

Objective. To evaluate the presence of psychiatric alterations in patients with fecal incontinence. Patients and method. Eighty consecutive patients (67 women) with fecal incontinence were evaluated. All the patients completed the the specific GHQ-28 questionnaire to evaluate psychiatric symptoms. The questionnaire had previously been validated in the Spanish language. A score equal to or higher than 6 points was considered to indicate pathology. Incontinence was evaluated by the Cleveland Clinic Florida-Fecal Incontinence severity score (range 0 - 20). Psychiatric antecedents prior to fecal incontinence were recorded. Results. Thirty-two patients (40%) had pathological scores on the GHQ-28 questionnaire (mean 13.59, range: 7-26). The mean Cleveland score was 11.52 (range: 2-20). Patients with pathological GHQ-28 scores had higher fecal incontinence scores (14.28 vs 9.68; p < 0.0001). A significant lineal correlation was found between GHQ-28 scores and the severity of fecal incontinence (p < 0.0001). Psychiatric antecedents were found in 17 patients (21.3%). In these patients no correlation was found between GHQ-28 score and the severity of incontinence. In the subgroup of patients without psychiatric antecedents this correlation was maintained (p < 0.003). Of these, 20 (31.7%) had pathologic scores on the GHQ-28, and the mean incontinence severity score was significantly higher than that of those with a normal GHQ-28 score (13.15 vs. 9.25; p < 0.004). Conclusions. The prevalence of psychiatric alterations is high in patients with fecal incontinence and is correlated with its severity. Patients with psychiatric antecedents can bias evaluation of the association between psychiatric alterations and the severity of fecal incontinence (AU)

Introducción de la laparoscopia en el tratamiento del cáncer de recto en una unidad de coloproctología / Introduction of laparoscopy in the treatment of rectal cancer in acoloproctology unit

Objetivo. La aplicación de la vía laparoscópica al tratamiento del cáncer de recto es un tema controvertido. El objetivo de este trabajo ha sido valorar si la introducción de esta técnica en una unidad de coloproctología ha supuesto alguna merma en la calidad de la cirugía del cáncer de recto. Material y método. Estudio prospectivo no aleatorizado que ha incluido a todos los pacientes con neoplasia de recto intervenidos con intención curativa en los años 2003 y 2004, excluyendo los tumores estadiados preoperatoriamente como T4. De los 59 pacientes incluidos, se intervino por vía laparoscópica a 33 y por vía abierta a 26. En estos 2 grupos de pacientes se ha estudiado comparativamente una serie de variables intraoperatorias, postoperatorias y de la pieza quirúrgica. Resultados. No hubo diferencias entre los 2 grupos en el tipo de intervención practicada ni en la tasa de preservación esfinteriana. La morbilidad global fue del 39% en el grupo de cirugía laparoscópica y del 34% en el grupo de cirugía abierta, sin diferencias significativas. La dehiscencia anastomótica fue del 9,5 y el 5,8%, respectivamente, sin diferencias significativas. Las estancias hospitalarias fueron similares. El margen distal fue adecuado en todos los casos. El margen de resección circunferencial fue positivo (< 1 mm) en el 10,7% de los pacientes del grupo laparoscópico sometidos a exéresis total del mesorrecto y en el 13,6% de los del grupo abierto, sin diferencias significativas. La media de ganglios aislados fue de 12,5 en el grupo de cirugía laparoscópica y de 15,5 en el grupo de cirugía abierta, sin diferencias significativas. Conclusiones. La introducción en nuestra unidad de la vía laparoscópica para el tratamiento del cáncer de recto no ha supuesto un detrimento en la calidad de la cirugía, medida ésta por parámetros clínicos y anatomopatológicos (AU)

Introduction. The application of the laparoscopic approach to the treatment of rectal cancer is controversial. The aim of the present study was to evaluate whether the introduction of this technique in a coloproctology unit modified the quality of rectal cancer surgery. Material and method. We performed a prospective, nonrandomized study of all patients with rectal cancer who underwent surgery with curative intent in 2003 and 2004. Patients with stage T4 tumors were excluded. Of the 59 patients included, 33 underwent laparoscopic surgery and 26 underwent open surgery. A series of intraoperative and postoperative variables and characteristics of the surgical specimen were compared between the two groups. Results. No differences were found between the two groups in the type of intervention performed or in the rate of sphincter preservation. Overall morbidity was 39% in the laparoscopic group and 34% in the open surgery group (NS). Anastomotic dehiscence was 9.5% and 5.8% respectively (NS). The length of hospital stay was similar in both groups. The distal margin was adequate in all patients. The circumferential resection margin was positive (< 1 mm) in 10.7% of patients in the laparoscopic group who underwent total mesorectal excision and in 13.6% of those in the open surgery group (NS). The mean number of isolated nodes was 12.5 in the laparoscopic group and 15.5 in the open surgery group (NS). Conclusion. The introduction of the laparoscopic approach in the treatment of rectal cancer in our unit has not lowered surgical quality, as measured by clinical and histopathological variables (AU)

Fisura de ano. Alteraciones de la continencia y de la calidad de vida durante la enfermedad y a los 6 meses de la esfinterotomía lateral interna subcutánea / Fissure-in-ano. Alterations in incotinence and quality of life during disease and at six months after lateral subcutaneous internal sphincterotomy

Objetivo. El objeto de este trabajo prospectivo, en el que cada paciente era su propio control, ha sido evaluar las alteraciones de la continencia y de la calidad de vida producidas por la esfinterotomía lateral interna. Pacientes y método. En 113 pacientes consecutivos diagnosticados de fisura crónica anal se valoraron la calidad de vida (cuestionario SF-36) y la continencia fecal (cuestionario CCF-FI) antes de realizar una esfinterotomía lateral interna y a los 6 meses de la operación. Resultados. Se excluyó a 4 pacientes por la imposibilidad de rellenar el cuestionario SF-36 sin ayuda. De los 109 restantes, en 6 (5,5%) la fisura persistió o recidivó. Un paciente no aceptó volver a rellenar la encuesta de calidad de vida, por lo que fue excluido del estudio. En los 108 pacientes en los que el estudio se completó, aumentó la incontinencia, la mediana (amplitud intercuartil) de las puntuaciones de la escala CCF-FI se incrementó de 0,00 (3) antes de la operación a 1 (4) en el postoperatorio (p = 0,001). La calidad de vida mejoró de forma significativa después de la operación, ya que las puntuaciones de las escalas siguientes aumentaron: función física (p = 0,005), rol físico (p = 0,006), dolor corporal (p < 0,001), vitalidad (p = 0,008), función social (p = 0,022) y salud mental (p < 0,001). No hubo diferencias estadística-mente significativas en la percepción de salud en general y en el rol emocional. Conclusión. A pesar del deterioro de la continencia, la esfinterotomía mejora la calidad de vida en los pacientes con fisura anal (AU)

Objective. To prospectively evaluate alterations in continence and quality of life produced by lateral internal sphincterotomy with each patient acting as his or her own control. Patients and method. Quality of life (SF-36 questionnaire) and fecal incontinence (Cleveland Clinic Florida-Fecal Incontinence [CCF-FI] questionnaire) were evaluated before and 6 months after lateral internal sphincterotomy was performed in 113 consecutive patients diagnosed with chronic anal fissure. Results. Four patients were excluded because of their inability to complete the SF-36 questionnaire without help. Of the 109 remaining patients, there was persistence or relapse of anal fissure in six (5.5%). One patient refused to complete the quality of life questionnaire again and was excluded from the study. Of the 108 patients who completed the study, the median (interquartile range) score in the CCF-FI scale increased from 0.00 (3) before the intervention to 1(4) in the postoperative period (p = 0.001). Quality of life significantly improved after the operation, since the scores of the following scales increased: physical functioning (p = 0,005), role limitations-physical (p = 0.006), bodily pain (p < 0.001), vitality (p = 0.008), social functioning (p = 0.022) and mental health (p < 0.001). No statistically significant differences were found in general health perception or in role limitations-emotional. Conclusion. Despite deterioration in continence, sphincterotomy improves quality of life in patients with anal fissure (AU)

Estudio comparativo de la hemorroidopexia y la hemorroidectomía en el tratamiento de las hemorroides de cuarto grado / Comparative study of hemorrhoidopexy and hemorrhoidectomy in the treatment of grade IV hemorrhoids

Objetivo. El objetivo de este estudio aleatorizado ha sido comparar los resultados de la hemorroidopexia con los de la hemorroidectomía realizada con diatermia en el tratamiento de las hemorroides de cuarto grado. Método. Se asignó de forma aleatoria a 31 pacientes con hemorroides de cuarto grado sintomáticas a 2 grupos de tratamiento: hemorroidopexia (n = 15) y hemorroidectomía con diatermia (n = 16). Se valoró el control de los síntomas un año después de la intervención. Resultados. Ocho pacientes en el grupo de la hemorroidopexia y ninguno de los tratados con una hemorroidectomía presentaron una recidiva del prolapso (p = 0,001). Además, 6 pacientes en el grupo de la hemorroidopexia referían prurito, síntoma que sólo estaba presente en un paciente tratado con hemorroidectomía (p = 0,03) La hemorragia se resolvió igual con ambas técnicas. Por otra parte, 6 pacientes tratados mediante hemorroidopexia tenían tenesmo, síntoma que sólo estaba presente en un paciente tratado con hemorroidectomía (p = 0,007). Conclusión. La hemorroidopexia no cura el prolapso ni el prurito en las hemorroides de cuarto grado y produce un nuevo síntoma, el tenesmo (AU)

Valor de la ecografía endoanal con inyección de agua oxigenada en el diagnóstico de las fístulas perianales / Value of hydrogen peroxide-enhanced endoanal ultrasonography in the diagnosis of perianal fistulas

Introducción. La utilidad de la ecografía endoanal en el diagnóstico de las fístulas de ano es controvertida. El objetivo de este estudio prospectivo ha sido determinar la exactitud de la ecografía endoanal mejorada con agua oxigenada empleando los hallazgos quirúrgicos como método de validación.Pacientes y métodos. Se estudió a 143 pacientes consecutivos (102 varones; edad media, 45 años) diagnosticados de fístula de ano de etiología criptoglandular. Las ecografías se realizaron por un único radiólogo con un aparato de ultrasonidos B&K y una sonda rotatoria de 7 MHz, inyectando agua oxigenada al 3 por ciento por el orificio externo. Todos los pacientes fueron intervenidos por un único cirujano que desconocía los hallazgos de la ecografía.Resultados. Mediante la exploración quirúrgica no se pudo encontrar el orificio interno de la fístula en 15 pacientes, que fueron excluidos del estudio (10,5 por ciento). De los 128 pacientes restantes, con la ecografía se encontró el orificio interno de la fístula en 80 (62,5 por ciento). La tasa de aciertos para cada tipo de fístula fue: ocho de 25 casos de fístulas interesfinterianas (32 por ciento), 70 de 91 transesfinterianas (77 por ciento) y dos de 12 supraesfinterianas (17 por ciento). La sensibilidad de la prueba fue del 62,5 por ciento.Conclusión. La ecografía endoanal carece de la exactitud suficiente para ser empleada como un medio diagnóstico de rutina en los pacientes con fístula de ano. (AU)

Función defecatoria y calidad de vida con la cirugía preservadora de esfínteres en el cáncer de recto / Defecatory function and quality of life with sphincter-preserving surgery in rectal cancer

La cirugía preservadora de esfínteres para el tratamiento del cáncer de recto se propuso como alternativa a la amputación abdominoperineal con colostomía definitiva por el rechazo que generaba en los pacientes. Sin embargo, estos pacientes van a presentar una serie de alteraciones de la función defecatoria, consistentes en urgencia, tenesmo, aumento de la frecuencia deposicional, sensación de evacuación incompleta, ritmo defecatorio errático y grados variables de incontinencia anal. Este conjunto de problemas se han agrupado bajo el nombre de síndrome de la resección anterior, que puede afectar a más del 60 per cent de los pacientes y cuyas causas no están suficientemente explicadas. La anastomosis coloanal con reservorio se ha propuesto como una solución para incrementar la capacidad del colon anastomosado, consiguiendo mejorar la frecuencia defecatoria, pero no el resto de problemas del síndrome de la resección anterior. Incluso presenta problemas nuevos, como dificultad de evacuación, por lo que se aconsejan reservorios más pequeños. Por tanto, la cirugía del cáncer de recto, tanto sea una resección anterior baja como una amputación abdominoperineal, produce una serie de alteraciones físicas, psíquicas y sociales que van a tener una influencia sobre la calidad de vida de los pacientes. Así, los primeros estudios que compararon ambas operaciones encontraban que las dos alteraban la calidad de vida, si bien la presencia de un estoma definitivo la alteraba más. Con la introducción de instrumentos específicos para valorar la calidad de vida en pacientes con cáncer (EORTC-C30) y con cáncer colorrectal (EORTC-C38) se ha confirmado cómo tanto la amputación abdominoperineal como la cirugía preservadora de esfínteres alteran la calidad de vida, pero no se han demostrado claras diferencias entre una u otra operación. Igualmente, las puntuaciones de las diferentes escalas mejoran con el transcurso del tiempo. The sphincter- saving surgery for the treatment of the cancer of rectum, was proposed as alternative to the abdominoperineal resection with definitive colostomy for the rejection that generated in the patients. However, these patients will present a number of alterations of the defecatory function, consistent in: urgency, tenesmus, increase of the bowel movement per day, sensation of incomplete evacuation, erratic defecatory rhythm, and several degrees of fecal incontinence. These of problems have been grouped under the name of the anterior resection syndrome (ARS) that can affect to more than 60 per cent of the patients. The causes of ARS have not sufficiently explained. The coloanal anastomosis and colonic J pouch has proposed like a solution to increase the capacity of the colon, being able to improve the defecatory frequency, but not the rest of problems of the syndrome of the previous resection. It even presents new problems, as difficulty to evacuation. Therefore preserving surgery like an abdominoperineal resection, produce several physical, psychic and social alterations that they will have an influence on the quality of life of the patients. The initial studies comparing both operations found that both altered the quality of life, although the presence of a definitive stoma altered it more. The introduction of specific instruments to value the quality of life in patient with cancer (EORTC-C30) and with cancer colorrectal Función defecatoria y calidad de vida con la cirugía preservadora de esfínteres en el cáncer de recto. (AU)