Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy.
These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy.
Dr Britt Hupkens and colleagues examined whether this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome.
The researchers compared the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery.
The team performed a matched controlled study conducted at multiple centers.
The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery.
|The watch-and-wait group had better physical and cognitive function|
|Diseases of the Colon & Rectum|
Patients were matched on sex, age, tumor stage, and tumor height.
All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years.
The team measured quality of life by validated questionnaires covering general quality of life, disease-specific total mesorectal excision, defecation problems, sexual problems, and urinary dysfunction.
The researchers showed that the watch-and-wait group had better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function.
Dr Hupkens' team comments, "After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains."
"However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 67% of the patients in the total mesorectal excision group."