Purpose Anterior resection (AR) is associated with postoperative bowel dysfunction, but long-term data on bowel, bladder and sexual function following AR versus right hemicolectomy (RH) are limited. This study compared long-term functional outcomes and health-related quality of life(HRQoL) between patients undergoing AR and RH using validated questionnaires. Methodology A prospective cohort study was conducted at a tertiary referral centre, including consecutive patients who underwent AR or RH for colorectal adenocarcinoma between 2015 and 2024. All patients alive and without a stoma completed a postal questionnaire in 2025. Bowel function was assessed using the Low Anterior Resection Syndrome(LARS), St Mark’s incontinence, Altomare obstructed defaecation syndrome(ODS) and Wexner constipation scores. Bladder function was evaluated using sex-specific ICIQ-MLUTS and ICIQ-FLUTS questionnaires. Generic and cancer-specific quality of life were assessed using SF-36v2, EORTC QLQ-C30, and QLQ-CR29. Outcomes were compared using univariate and age-adjusted analyses. Results A total of 206 patients were included(133 AR, 73 RH).The AR group was younger(70.8 vs 77.8 years, p<0.001); and included fewer men(63.9% vs 72.2%, p=0.016). AR patients reported worse bowel outcomes, including higher prevalence of major LARS(28.6% vs 11.0%, p=0.002), higher St Mark’s incontinence scores(p=0.002), and higher ODS scores p=0.006). Stool frequency and diarrhoea scores were worse following AR on EORTC QLQ-C30 and QLQ-CR29. Bladder function did not differ between groups. Female sexual function was lower following AR, while male sexual function was comparable. Overall HRQoL was similar, although RH patients reported greater bodily and abdominal pain. Conclusion AR is associated with greater long-term burden of bowel dysfunction and selected sexual function impairments compared with RH, despite similar HRQoL. This unique long-term comparison informs patient counselling and surgical decision-making.