Functional Outcomes in Patients With Rectal Cancer After Low Anterior Resection Compared to Watch-and-Wait – A Systematic Review and Meta-Analysis

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ID: 315780
2026
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Abstract
Abstract Background Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision is the standard treatment for locally advanced rectal cancer. When sphincter preservation is feasible, low anterior resection (LAR) is commonly performed but often leads to long-term bowel dysfunction, referred to as low anterior resection syndrome (LARS). In patients achieving a clinical complete response after CRT, a watch-and-wait (W&W) strategy has emerged as a non-operative alternative to preserve rectal function. However, comparative evidence on bowel function remains heterogeneous. Aims To compare bowel functional outcomes, particularly LARS severity, in rectal cancer patients after neoadjuvant CRT managed with W&W strategy versus LAR. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of bowel function in rectal cancer patients after CRT managed with W&W strategy versus those undergoing LAR. The primary outcome was bowel dysfunction assessed with validated instruments, with LARS severity pooled as a standardized mean difference (SMD) from continuous or, in one study, from categorical data. Random-effects models accounted for between-study heterogeneity. Results Seven non-randomized comparative studies (n = 530; W&W 364, LAR 166; median follow-up ∼24 months) were included. In studies using the LARS score (n = 4; W&W 302, LAR 124), W&W showed significantly better bowel function than LAR (SMD −0.79, 95% CI −1.22 to −0.37; no heterogeneity). Sensitivity analyses limited to continuous mean LARS scores were consistent. Overall pooled analysis indicated a non-significant trend favoring W&W (SMD −0.53, 95% CI −1.28 to 0.22; moderate heterogeneity). Secondary analyses using alternative instruments were directionally concordant but underpowered. Conclusion Among rectal cancer patients achieving a clinical complete response after CRT, W&W is associated with better bowel function than after LAR when assessed using continuous LARS measures. These findings support the consideration of organ-preserving strategies in appropriately selected patients and highlight bowel function as a key component of shared decision-making alongside oncological outcomes.
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openalex_W7163337294 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors B Kqiku, F Wiedemann, M von Strauss Und Torney, D Steinemann, B P Müller
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag055.044
URL
https://doi.org/10.1093/bjs/znag055.044
Keywords Keywords not found

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