Clinical contexts for Shared Decision-Making in rectal cancer: Organ preservation, sphincter-sparing surgery and tailored stoma policy

Abstract

The management of rectal cancer has evolved into a patient-centered multidisciplinary approach emphasizing oncological safety, quality of life (QoL), and functional outcomes. Shared Decision-Making (SDM) plays a pivotal role in navigating treatment strategies that balance these aspects. Rather than reviewing existing SDM interventions, this narrative review explores clinical situations where SDM could significantly support the decision-making process. We focus on three critical therapeutic domains: organ preservation, sphincter preservation and temporary stoma policies, where treatment decisions involve significant trade-offs and patients' preferences. Emerging strategies like the "watch-and-wait" approach and local excision in carefully selected patients have shown potential in preserving the rectum without compromising oncological outcomes. Sphincter-preserving techniques, including intersphincteric resection, offer alternatives to permanent stomas, though they require careful consideration of potential functional impacts such as Low Anterior Resection Syndrome (LARS). Regarding temporary stomas, innovations in closure timing and tailored risk stratification methods aim to reduce stoma-related complications and improve patient QoL. This review examines the different therapeutic options, highlighting decision points where SDM can support individualized care and facilitate personalized treatment planning. By integrating SDM into these clinical pathways, healthcare teams and patients can collaboratively align treatment recommendations with patients' preferences, ultimately improving outcomes and patient satisfaction.

Keywords: Intersphincteric resection; Local excision; Organ preservation; Quality of life; Rectal cancer; Shared decision-making; Sphincter preservation; Temporary ileostomy; Watch-and-Wait.