Quality of life and functional outcomes after rectal sparing approaches following neoadjuvant therapy for rectal cancer: a prospective cohort multicentre study

Background: This prospective observational multicenter cohort study aimed to establish the functional outcomes and quality of life (QoL) of patients with rectal cancer who showed a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy and underwent a rectum sparing approach (watch and wait, WW, or local excision, LE). Materials and methods: QoL and functional function were investigated using the EORTC QLQ-30, EORTC QLQ-CR29, the MSKCC bowel function instrument, and the FIQL index. Patients filled these questionnaires at the time of enrolment (T1), and 6 (T2) and 12 months (T3) thereafter. Variation overtime for each group and comparisons between cCR patients who underwent WW or LE were performed. Results: Of 161 patients who were enrolled, 112 had a cCR (LE n = 50, WW n = 62) and 49 a mCR (all LE). LE patients showed changes after surgery, WW patients showed more gradual changes. LE patients showed reduced anxiety and depression and improved emotional functioning but also an increased fecal incontinence and reduced sexual function in men after surgery. WW patients showed a significant improvement overtime in role functioning and anxiety, while their diarrhea and stool frequency progressively reduced. Among patients with a cCR, LE patients showed a significantly higher incontinence compared to WW patients. However, the two groups did not differ in terms of impact of incontinence on QoL. Conclusion: Functional outcomes and QoL of patients underwent to WW or LE approach generally improve overtime, but LE patients also showed some impact of surgery.