QS205 - Quality Of Life And Functional Outcomes In Rectal Cancer Patients: Prospective Comparative Analysis Of “Watch-And-Wait” Strategy Vs Low Anterior Resection

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Purpose/Background: This study aims to compare the quality of life (QoL) measures in rectal cancer patients managed with Watch-and-Wait strategy (WW) with those treated with low anterior resection (LAR).

Methods/Interventions: Rectal cancer patients treated with WW (WW group) or LAR (LAR group) between 2021 and 2024 were enrolled in this prospective study. The study protocol received approval from the institutional ethics committee, and informed consent was obtained from all participants. QoL and functional outcomes were assessed with comprehensive set of instruments, including the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29, the Low Anterior Resection Syndrome (LARS) score, the Vaizey and Wexner incontinence scores, the International Index of Erectile Dysfunction (IIEF), the International Prostate Symptom Score (IPSS), and the Female Sexual Function Index (FSFI). All questionnaires had been previously validated in the Turkish population and were administered 6 to 12 months after the decision for WW or the LAR procedure (or stoma closure for patients with a diverting ileostomy during the initial surgery). A per-protocol analysis was conducted, wherein patients who required LAR following WW management were reassigned to the LAR group for outcome analysis. The results were compared between the WW and LAR groups.

Results/Outcomes: A total of 31 patients (22 males [71%], mean age 55 ± 2.28 years) were included in the WW group, while the LAR group comprised 48 patients (28 males [74%], mean age 57 ± 1.88 years). Tumor locations were comparable between the two groups, with mean distances of 6 ± 0.58 cm and 7 ± 0.64 cm from the dentate line (p = 0.38), and there were no statistically significant differences in T and N stages or neoadjuvant therapy regimens. There were 17 (refusal in participation [n=5], non-national residency [n=2], total mesorectal excision [n=4] or local excision [n=2] due to regrowth) and 38 (refusal in participation [n=7] and non-national residency [n=3]) responders in WW and LAR groups, respectively. EORTC QLQ-C30 and QLQ-CR29 demonstrated that multiple functional and symptom scales were statistically significantly superior in the WW group, as illustrated in Figure 1. There were 2 (12%) and 30 (79%) patients experiencing major LARS in WW and LAR groups, respectively (p < 0.001). LARS (14.52±12.89 vs 31.27±8.53, p< 0.001), Vaizey (4.17±4.73 vs 11.25±7.01, p< 0.001) and Wexner (3.47±3.93 vs 9.41±6.32, p< 0.001) scores were significantly favorable in WW group. Other outcome measures were comparable between the two groups. The principal limitations of this study were the small sample size and the absence of evaluated measures at the time of presentation.

Conclusion/Discussion: Quality of life appears to be superior in patients managed with the WW protocol compared to those undergoing LAR. While LARS or incontinence may occur in WW patients as a consequence of neoadjuvant treatment modalities, these complications are observed to occur with greater frequency following the LAR procedure.