Skip to main content
2025 ASCRS Annual Scientific Meeting Main banner
Final Program


Visit ASCRS U
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Self-Assessment
Self-Assessment
Social
Social
Industry
Industry
Back

Session: ePoster: Rectal Cancer 8 (Mon1015)

EP753 - Quality of life and functional outcomes after watch-and-wait for locally advanced rectal cancer: A systematic review and meta-analysis

Monday, May 12, 2025
10:42 AM – 10:47 AM PT

    Author(s)

  • Racquel S. Gaetani, MD (she/her/hers)

    General Surgery Resident/Colorectal Research Fellow
    LAHEY HOSPITAL AND MEDICAL CENTER
    Lahey Hospital and Medical Center
    Burlington, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • ePoster Presenter(s)

  • Sowmya Sharma, MD (she/her/hers)

    General Surgery Resident
    LAHEY HOSPITAL AND MEDICAL CENTER
    Lahey Clinic
    Burlington, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • TZ

    Tasneem S. Zaihra Rizvi, PhD

    Senior Statistician
    LAHEY Hospital and Medical Center
    Burlington, Massachusetts, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jonathan S. Abelson, MD MS (he/him/his)

    Staff Surgeon
    Lahey Hospital and Medical Center
    Tufts Medical Center
    Arlington, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Racquel S. Gaetani, MD: This individual has no financial relationships with ineligible companies.
Sowmya Sharma, MD: This individual has no financial relationships with ineligible companies.
Jonathan S. Abelson, MD MS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Watch and wait (WW), which includes total neoadjuvant therapy (TNT) followed by close observation, has emerged as an alternative to total mesorectal excision (TME) for patients with locally advanced rectal cancer (LARC) who had clinically complete response (cCR) or near clinically complete response (nCR). This strategy aims to preserve organ function and improve quality of life (QoL) and functional outcomes, particularly low anterior resection syndrome (LARS) and incontinence. In this systematic review, we reviewed the existing data assessing QoL and functional outcomes in patients who underwent TME compared to TNT and WW for LARC.

Methods/Interventions: This review was conducted in adherence to the Cochrane guidelines. PUBMED, Medline, EMBASE, and Web of Science, as well as a hand search conducted in selected journals. The full protocol is submitted to Prospero: CRD42024523392. QoL was measured with the European Organisation for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ) C30 or C29, or Fecal Incontinence Quality of Life Scale (FIQL). The following functional outcome assessment measures were included: LARS score, Cleaveland Clinic Florida Fecal Incontinence Score (CCF-FIS), Wexner score, St. Mark’s score, Vaizey Score, and Memorial Sloan Kettering Bowel Function Instrument (MSKCC). Exclusion criteria included patients with metastatic disease or patients who did not achieve cCR or nCR after TNT. Case reports, case series and meta-analyses were also excluded.

Results/Outcomes: A total of 8 studies were included in this systematic review. Of note, 4 studies assessed patients purely with LARC, while 4 studies included LARC as well as early-stage rectal cancer. The analysis revealed that patients in the WW group reported statistically significantly better QoL compared to those who underwent TME. Regarding incontinence, patients in the WW group generally reported better scores, suggesting less incontinence compared to those who underwent TME; however, this difference was not statistically significant. One longitudinal study found that although initial differences in incontinence scores favored the WW group, these differences disappeared by 24 months.
Only 2 studies assessed LARS and were not included in the meta-analysis. One study was unable to compare WW and TME and found that LARS scores remained stable in WW patients over 24 months, with major LARS rate of 25.3% at 3 months and 24.9% at 24 months. The other study reported major LARS in 67% of TME patients, compared to 17% in the WW group.

Conclusion/Discussion: In conclusion, WW may offer significant QoL advantages when compared with TME during the early postoperative period. The decision to pursue WW should be individualized, considering both the potential functional benefits and the oncological risks. Understanding these QoL and functional benefits can be beneficial for providers and patients to make these decisions together.