Colostomies may influence patient quality of life more than poor sphincter function.

To the Editor:Minsky,1 in his recent Editorial, suggested that "A well-functioning colostomy may offer a better quality of life than a poorly functioning sphincter". After this statement, he referred to Grumann et al’s study2 that concluded "Patients undergoing low AR [anterior resection] have a lower QoL [quality of life] than those undergoing APE [abdominoperineal extirpation]." First, Minsky writes that Grumann compared 23 abdominoperineal resection (APR) patients with 50 low anterior resection (AR) patients. The comparison Grumann conducted, however, was between 23 APR patients and 50 AR patients, consisting of 15 low AR patients and 35 high AR patients grouped together as AR patients. Grumann et al also described an analysis between low and high AR patients. At no stage, however, was a statistical comparison between low AR and APR patients reported, despite conclusions to this effect. Further, an editorial following the article suggested "...it may be wrong to conclude that patients had improved quality of life following abdominoperineal resection..."