Quality of Life Outcomes Following Organ-Preserving Treatment in Rectal Cancer

Abstract

Organ-preserving strategies for rectal cancer -- watch-and-wait surveillance after a clinical complete response to neoadjuvant therapy, and local excision of near-complete-response tumors -- now rest on a substantial base of registry and randomized-trial evidence supporting their oncologic safety in appropriately selected patients. Less consolidated is the quality-of-life (QoL) case for these strategies specifically: whether avoiding radical resection actually translates into better patient-reported bowel, urinary, sexual, and global function, and by how much. This short communication synthesizes that evidence using validated instruments -- the EORTC QLQ-CR29 module and the Low Anterior Resection Syndrome (LARS) score in particular -- across matched-cohort and long-term follow-up studies comparing organ preservation with standard total mesorectal excision. The bowel-function advantage for organ preservation is the most consistent and quantitatively largest finding, with major LARS symptoms reported by roughly one-third of watch-and-wait patients versus two-thirds of matched surgical patients in the best available matched comparison, alongside better global health status and body image. Evidence for sexual, urinary, and psychological outcomes specific to the organ-preservation comparison remains comparatively thin. We conclude that standardized, longitudinal, patient-reported outcome collection, as recently called for by international consensus, is needed to convert a directionally favorable but methodologically uneven QoL picture into evidence solid enough to fully inform shared decision-making.