Functional Outcomes and Quality of Life in Patients Managed With Organ Preservation Following Total Neoadjuvant Therapy for Rectal Cancer—A Historical Cohort Study

Aim Total neoadjuvant therapy (TNT) for locally advanced rectal cancer improves oncological outcomes and organ preservation rates, but the impact on patient quality of life (QoL) is not known. This cohort study compares the quality of life (QoL) of post‐TNT watch‐and‐wait (W&W) patients to a historical cohort of patients that underwent standard care. Method Patients managed with a W&W approach following a personalised TNT (pTNT W&W group) were compared with historical group patients who had undergone standard treatment but who would have been eligible for pTNT under our current protocol (STD group). Patients were sent three questionnaires to complete: Survey of International Delphi consensus definition for lower anterior resection syndrome (LARS) symptoms, EORTC‐QLQ‐CR29, and the LARS score. Results Questionnaires were completed for 29 of 41 patients in the pTNT W&W group, and 33 of 63 patients in the STD group (a response rate of 70.7% and 52.4%, respectively). Patients were well matched at baseline. The pTNT W&W group had significantly lower LARS rates (55.6% vs. 87.5%, p = 0.012) with fewer cases of major LARS (29.6% vs. 58.3%, p = 0.039). The pTNT W&W also had significantly improved QoL scores across several parameters of EORTC–QLQ–CR29 including stool frequency (20.7 vs. 30.8, p = 0.009), embarrassment regarding bowel symptoms (16.1 vs. 31.3, p = 0.018), and abdominal pain (5.8 vs. 14.1, p = 0.005). Conclusions Despite retaining the irradiated rectum, patients managed with organ preservation after TNT experience a higher QoL with much lower, but not absent, rates of bowel and bladder dysfunction.