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Observational Study
. 2020 Jul;63(7):897-902.
doi: 10.1097/DCR.0000000000001646.

Patient-Reported Bowel Function in Patients With Rectal Cancer Managed by a Watch-and-Wait Strategy After Neoadjuvant Therapy: A Case-Control Study

Felipe F Quezada-Diaz  1 , J Joshua Smith  1 , Rosa M Jimenez-Rodriguez  1 , Isaac Wasserman  1 , Emmanouil P Pappou  1 , Sujata Patil  2 , Iris H Wei  1 , Garrett M Nash  1 , Jose G Guillem  1 , Martin R Weiser  1 , Philip B Paty  1 , Julio Garcia-Aguilar  1
Affiliations
Observational Study

Patient-Reported Bowel Function in Patients With Rectal Cancer Managed by a Watch-and-Wait Strategy After Neoadjuvant Therapy: A Case-Control Study

Felipe F Quezada-Diaz et al. Dis Colon Rectum. 2020 Jul.

Abstract

Background: A watch-and-wait strategy is a nonoperative alternative to sphincter-preserving surgery for patients with locally advanced rectal cancer who achieve a clinical complete response after neoadjuvant therapy. There are limited data about bowel function for patients undergoing this organ-preservation approach.

Objective: The purpose of this study was to compare bowel function in patients with rectal cancer managed with a watch-and-wait approach with bowel function in patients who underwent sphincter-preserving surgery (total mesorectal excision).

Design: This was a retrospective case-control study using patient-reported outcomes.

Settings: The study was conducted at a comprehensive cancer center.

Patients: Twenty-one patients underwent a watch-and-wait approach and were matched 1:1 with 21 patients from a pool of 190 patients who underwent sphincter-preserving surgery, based on age, sex, and tumor distance from the anal verge.

Main outcome measures: Bowel function was measured using the Memorial Sloan Kettering Cancer Center Bowel Function Instrument.

Results: Patients in the watch-and-wait arm had better bowel function on the overall scale (median total score, 76 vs 55; p < 0.001) and on all of the subscales, with the greatest difference on the urgency/soilage subscale (median score, 20 vs 12; p < 0.001).

Limitations: The study was limited by its retrospective design, small sample size, and temporal variability between surgery and time of questionnaire completion.

Conclusions: A watch-and-wait strategy correlated with overall better bowel function when compared with sphincter-preserving surgery using a comprehensive validated bowel dysfunction tool. See Video Abstract at http://links.lww.com/DCR/B218. FUNCIÓN EVACUATORIA INFORMADA POR PACIENTES EN CÁNCER RECTAL MANEJADO CON UNA ESTRATEGIA DE OBSERVAR Y ESPERAR DESPUÉS DE LA TERAPIA NEOADYUVANTE: UN ESTUDIO DE CASOS Y CONTROLES: Observar y esperar es una alternativa no operativa a la cirugía de preservación del esfínter para pacientes con cáncer rectal localmente avanzado que logran una respuesta clínica completa después de la terapia neoadyuvante. Hay datos limitados sobre la función evacuatoria en pacientes sometidos a este abordaje para preservación de órganos.Evaluar la función evacuatoria en pacientes con cáncer rectal manejados con observar y esperar comparado a pacientes sometidos a cirugía de preservación de esfínteres (escisión mesorrectal total).Estudio retrospectivo de casos y controles utilizando resultados reportados por pacientes.Centro especializado oncológico.21 pacientes se sometieron a observar y esperar y se compararon con 21 pacientes de un grupo de 190 pacientes que se sometieron a cirugía de preservación de esfínteres controlando por edad, sexo y la distancia del tumor al borde anal.Función evacuatoria utilizando un instrumento de valoración del Centro de Cáncer Memorial Sloan Kettering.Los pacientes de observar y esperar demostraron mejor función evacuatoria en la escala general (puntuación total media, 76 versus 55; p <0,001) y en todas las subescalas, con la mayor diferencia en la subescala de urgencia / ensuciamiento fecal (puntuación media, 20 versus 12; p <0,001).Diseño retrospectivo, numero de muestra pequeño y variabilidad temporal entre la cirugía y el tiempo de finalización del cuestionario.Observar y esperar se correlacionó con mejor función evacuatoria en general en comparación con la cirugía de preservación del esfínter utilizando una herramienta integral validada para la disfunción evacuatoria. Consulte Video Resumen en http://links.lww.com/DCR/B218. (Traducción-Dr. Adrián Ortega).

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Conflict of interest statement

Financial Disclosures: Dr. Garcia-Aguilar has received support from Medtronic, Johnson and Johnson, and Intuitive Surgical. Dr. Pappou and Smith have received travel support for fellowship education from Intuitive Surgical. Dr. Smith has served as a clinical advisor for Guardant Health, Inc. The other authors have no conflicts of interest or financial ties to disclose.

Figures

Figure 1.
Figure 1.
Patient cohorts. WW = watch and wait; SPTME = sphincter-preserving total mesorectal excision; MSK BFI = Memorial Sloan Kettering Bowel Function Instrument.
Figure 2.
Figure 2.
MSK BFI scores with interquartile and full ranges (n = 21 for each group). (A) Total scores; (B) subscale scores. MSK BFI = Memorial Sloan Kettering Bowel Function Instrument; WW = watch and wait; SPTME = sphincter-preserving total mesorectal excision.
Figure 2.
Figure 2.
MSK BFI scores with interquartile and full ranges (n = 21 for each group). (A) Total scores; (B) subscale scores. MSK BFI = Memorial Sloan Kettering Bowel Function Instrument; WW = watch and wait; SPTME = sphincter-preserving total mesorectal excision.
See this image and copyright information in PMC

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