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tention to cure. The goal of curative surgery in rectal cancer is tumor resection with adequate margins, which is addressed by performing a wide excision of the underlying soft tissue and associated lymph nodes. This implies an extension of tumor resection margins to at least 5 cm around the involved area. The surgical approach to rectal cancer considers the neoplasm’s location –upper (12 to 16 cm), middle (7.5 to 12 cm) or lower and anal canal (less than 7.5 cm); the distance from the tumor’s lower border to the linea dentata is the most significant factor when it comes to the selection of a procedure type. The standard management of this type of cancer is radical resection, either lower anterior resection or abdominoperineal amputation, depending on the tumor’s upper-mid location or lower-mid location, respectively (1). In the past few years significant improvements in surgical technique and technology itself have been made mostly regarding the development of suturing devices, which allowed a greater number of procedures with sphincter preservation, ultralow colorectal anastomosis, and coloanal anastomosis. A number of low tumors still require abdominoperineal amputation, however. Despite the aforementioned advances, rectal cancer surgery is burdened with the fact that these techniques are associated with high morbidity even in experienced hands, which results from anastomotic dehiscence, genitourinary dysfunction, fecal incontinence, permanent colostomy, etc. In addition, local recurrence develops in 15-50% of patients after conventional surgery, even following complete resection (2). Local recurrence is associated with positive resection margins, histologic differentiation grade, rectal wall invasion (T), and nodal infiltration (N). Therefore we envisage two interrelated groups of difficulties deriving from curative-intent surgery for rectal cancer: the morbidity arising from surgical techniques, which directly affects quality of life, and the potential for local recurrence of disease, which clearly relates to patient survival and, through therapies intended to prevent such recurrence, to morbidity and quality of life involving these subjects. Health is currently understood as a complete state of physical, mental, and social well-being, rather than merely an absence of disease (3). The fact of suffering from disease results in a multidimensional involvement of life, with changes in the personal, familiar, and social spheres. Thus, not only objective data such as mortality rate should be considered when assesing a disorder’s impact, but we should rather take into account the impact of disease on the subject’s self-perceived health, that is, on the subject’s quality of life. Quality of life is considered a subjective and dynamic characteristic of individuals, and is assessed by using various techniques such as personal interviewing and questionnaires. Measuring quality of life allows an asMorbidity associated with the management of rectal cancer and its impact on patient quality of life 1130-0108/2004/96/11/739-745 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2004 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 96, N.° 11, pp. 739-745, 2004