PURPOSE: This study was designed to evaluate possible social and geographic factors that could have an impact on quality of life in patients after abdominoperineal excision of the rectum. Although the number of patients with rectal cancer who need to be treated with abdominoperineal excision of the rectum and construction of permanent colostomy has greatly decreased in the past, there is still controversy about the influence on quality of life caused by this procedure. METH ODS: In a prospective trial, patients operated on for low rectal cancer by abdom inoperineal excision of the rectum were evaluated by a quality of life questionn aire, modified from The American Society of Colon and Rectal Surgeons questionna ire, to assess fecal incontinence. The results for the four domains of quality o f life (lifestyle, coping behavior, embarrassment, depression), as well as for s ubjective general health, were evaluated with regard to age, gender, education, and geographic origin in univariate and multivariate analyses. RESULTS: Thirteen institutions in 11 countries included data from 257 patients. Although the anal ysis of general health did not reveal any significant differences, the analysis of the four quality of life domains showed the significant influence of geograph ic origin. The presence of a permanent colostomy showed a consistently negative impact on patients in southern Europe as well as for patients of Arabic (Islamic ) origin. On the other hand, age, gender, and educational status did not reveal a statistically significant influence. CONCLUSIONS: This is the first study to s how the influence of geographic origin on quality of life of patients with a per manent colostomy. Possible factors that may influence the outcome of patients af ter surgical treatment of rectal cancer, such as weather, religion, or culture, should be taken into account when quality of life evaluations are considered. PURPOSE: This study was designed to evaluate possible social and geographic factors that could have an impact on quality of life in patients after abdominoperineal excision of the rectum. Although the number of patients with rectal cancer who need to be treated with abdominoperineal excision of the rectum and construction of permanent colostomy has greatly decreased in the past, thereis still controversy about the influence on quality of life caused by this procedure. METH ODS: In a prospective trial, patients operated on for low rectal cancer by abdom inoperineal excision of the rectum were evaluated by a quality of life questionn aire, modified from The American Society of Colon and Rectal Surgeons questionnaire, to assess fecal incontinence. The results for the four domains of quality of life (lifestyle, coping behavior, embarrassment, depression), as well as for s ubjective general health, were evaluated with regard to age, gender, education, and geographic origin in univariate and the multivariate analyzes. RESULTS: Thirteen institutions in general health did not reveal any significant differences, the analysis of the four quality of life domains showed the significant influence of geograph ic origin. presence of a permanent colostomy showed a consistently negative impact on patients in southern Europe as well as for patients of Arabic (Islamic) origin. On the other hand, age, gender, and educational status did not reveal a known significant effect. CONCLUSIONS: This is the first study to s how the influence the geographic origin on quality of life of patients with a per manent colostomy. Possible factors that may influence the outcome of patients af ter surgical treatment of rectal cancer, such as weather, religion, or culture, should be taken into account when quality of life evaluations are considered.