title: Impact of Organ-Preserving Strategies on Anorectal Function in Patients with Distal Rectal Cancer Following Neoadjuvant Chemoradiation.
abstract: BACKGROUND
  Organ-preserving strategies have been considered for patients with distal rectal cancer and complete or near-complete response to neoadjuvant chemoradiation to avoid the functional consequences of radical surgery. Transanal endoscopic microsurgery and no immediate surgery (watch and wait) have been considered in selected patients.
  
  
  OBJECTIVE
  The aim of this study is to compare anorectal function following these 2 organ-preserving strategies (transanal endoscopic microsurgery and watch and wait) for rectal cancer with complete or near-complete response to neoadjuvant chemoradiation.
  
  
  METHODS
  This study is based on the comparison of prospectively collected data.
  
  
  METHODS
  This study was conducted at a single center.
  
  
  METHODS
  Consecutive patients with distal rectal cancer undergoing neoadjuvant chemoradiation (50.4-54 Gy and 5-fluorouracil-based chemotherapy) were prospectively studied. Patients with complete clinical response were managed by watch and wait. Patients with near-complete response (≤3 cm, ycT1-2N0) were managed by transanal endoscopic microsurgery.
  
  
  METHODS
  Functional outcomes were determined by anorectal manometry and Fecal Incontinence Index and Quality of Life assessment.
  
  
  RESULTS
  Two groups of patients were included in the study. Twenty-nine patients with near-complete response undergoing transanal endoscopic microsurgery and 53 with complete response after watch and wait were assessed. Baseline features were similar between groups. Patients undergoing transanal endoscopic microsurgery had worse resting/squeeze pressures (p = 0.004) and rectal capacity (p = 0.002). In addition, their incontinence scores (2.3 vs. 6.5; p < 0.001) and quality-of-life questionnaire responses (in all domains; p ≤ 0.01) were significantly worse in comparison with patients undergoing watch and wait.
  
  
  CONCLUSIONS
  This study was limited by the small sample size and the absence of baseline anorectal function information.
  
  
  CONCLUSIONS
  Nonoperative management of patients with complete clinical response following chemoradiation results in better anorectal function in comparison with patients with near-complete response managed by transanal endoscopic microsurgery. In the absence of clinically detectable residual cancer, this latter approach may result in significant worsening of anorectal function.
authors.affiliation: 1 University of São Paulo School of Medicine, São Paulo, Brazil 2 Angelita & Joaquim Gama Institute, São Paulo, Brazil 3 Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil 4 Ludwig Institute for Cancer Research, São Paulo Branch, São Paulo, Brazil.
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Patricio B
authors.initials: PB
authors.lastname: Lynn
authors.forename: J Márcio N
authors.initials: JM
authors.lastname: Jorge
authors.forename: Guilherme P
authors.initials: GP
authors.lastname: São Julião
authors.forename: Igor
authors.initials: I
authors.lastname: Proscurshim
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gama-Rodrigues
authors.forename: Laura M
authors.initials: LM
authors.lastname: Fernandez
authors.forename: Rodrigo O
authors.initials: RO
authors.lastname: Perez
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D012074:Remission Induction; D000067369:Transanal Endoscopic Microsurgery; D016896:Treatment Outcome; D047368:Tumor Burden; D057832:Watchful Waiting
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil