Patient-Reported Outcomes After Neoadjuvant Therapy and Watch-and-Wait for Rectal Cancer: A Systematic Review and Meta-Analysis

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Abstract
Objective: To evaluate patient-reported outcomes (PROs) in rectal cancer patients who underwent neoadjuvant therapy followed by watch-and-wait. Background: Advancements in rectal cancer therapies have improved oncologic outcomes and increased focus on long-term treatment effects. Watch-and-wait, which aims for organ preservation in patients with a clinical complete response to neoadjuvant therapy, is used more frequently. While watch-and-wait may reduce functional impairments associated with proctectomy, its association with PROs is poorly understood. Methods: We performed a systematic review and meta-analysis of studies reporting PROs for patients with stage I–III rectal adenocarcinoma treated with neoadjuvant therapy and watch-and-wait. Random-effects model meta-analysis was performed when feasible; otherwise, data were synthesized through a narrative review. Results: Twenty-five studies (3139 patients) reported PROs for patients receiving neoadjuvant therapy followed by watch-and-wait (n = 1283), proctectomy (n = 1583), local excision (n = 263), or declined surgery (n = 10). Most studies (64.0%) excluded patients with local regrowth, leaving PRO data for 103 such patients. Fourteen studies compared PROs between treatment groups after neoadjuvant therapy. Meta-analyses demonstrated fewer bowel symptoms and improved quality of life (QoL) in 1/6 subscales for watch-and-wait. Across 24 QoL comparisons, 14 showed improvement in some subscales for watch-and-wait, while 10 found no difference. For 24 symptom scale comparisons, 11 indicated some improvement with watch-and-wait, and 13 found no differences between groups. Conclusions: Watch-and-wait offers the potential to avoid permanent ostomy and surgical morbidity. However, more robust data are needed to assess its association with PROs compared to proctectomy or local excision. Researchers should prioritize publishing QoL data to better inform shared decision-making.

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