Watch-and-Wait Linked to Better Quality of Life After Rectal Cancer Treatment

An unplanned post hoc cohort study published in JAMA Network Open examined quality of life after total neoadjuvant therapy for locally advanced rectal cancer. Investigators analyzed prospectively collected questionnaires from the CAO/ARO/AIO-12 and CAO/ARO/AIO-16 phase 2 trials, conducted at 19 German centers. Patients had cT3–cT4 or node-positive rectal adenocarcinoma. Adjusted analyses compared watch-and-wait with total mesorectal excision, defining a difference of at least 5 points as clinically meaningful.

Baseline questionnaires were available for 346 of 385 eligible patients (89.9%). Longitudinal analyses favored watch-and-wait for fecal incontinence (−21.2 points; 95% CI, −30.0 to −12.3), stool frequency (−19.8; 95% CI, −27.6 to −11.9), and global health status (+9.2; 95% CI, 3.2 to 15.2). Clinically meaningful, statistically significant differences also favored watch-and-wait for embarrassment, flatulence, buttock pain, and physical, social, and role functioning. Findings among 29 patients with sustained clinical complete response at three years also favored watch-and-wait across several functional domains compared with surgical comparator groups.

These findings may inform shared decision-making for patients considering watch-and-wait after a clinical complete response. However, this was not a randomized comparison of watch-and-wait versus surgery, limiting causal interpretation. Questionnaire availability fell to 185 patients (48.1%) at five years, adding uncertainty to long-term estimates. The analysis addresses patient-reported outcomes rather than establishing oncologic equivalence.