Cohort study of organ preservation and quality of life after total neoadjuvant treatment in rectal cancer

Data on quality of life (QOL) after total neoadjuvant therapy (TNT) are important for counseling patients on the benefits of watch-and-wait (WW) versus total mesorectal excision (TME) for rectal cancer. A post-hoc cohort study using data from two phase 2 trials at 19 centers in Germany examined the assocation of organ preservation with QOL and functional outcomes among patients with rectal cancer. This cohort study of 385 patients treated with TNT incorporating chemoradiation found that WW versus TME was associated with clinically meaningful long-term functional and QOL benefits in various gastrointestinal domains (fecal incontinence, stool frequency, embarrassment, flatulence, buttock pain), social functioning, and overall health status. The authors conclude that in the absence of prospective randomized trials, these findings suggest that there are long-term, clinically meaningful QOL benefits for organ preservation in cases of complete clinical response after TNT, and may inform shared decision-making.