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Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy

2021; Elsevier BV; Volume: 86; Issue: 4 Linguagem: Inglês

10.1016/j.rgmxen.2020.07.009

2255-534X

A. Pascual-Russo, D. Milito, Lucila Facio, Marina Furia, V. Forestier, Soledad Iseas, Guillermo Méndez, Mariana Coraglio, Carlos Miguel Lumi, Guillermo Masciángioli, Eduardo Mauriño, Horacio Vázquez,

Stoma care and complications

The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). The WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence. La estrategia "watch and wait" (WW) es una alternativa a la resección anterior (RA) en pacientes con cáncer de recto (CR) con respuesta clínica completa a la neoadyuvancia. Existen pocos reportes que describan la calidad de vida (CV) y los trastornos funcionales anorrectales (TFA) en esta población. Analizar y comparar los TFA y la CV en pacientes con adenocarcinoma de recto localmente avanzados tratados con neoadyuvancia con diferentes estrategias: grupo 1 (G1): WW y grupo 2 (G2): RA. Se incluyeron 30 pacientes (G1: n = 20 y G2: n = 10) que cumplieron al menos 12 meses de finalizado el tratamiento neoadyuvante, edad mediana de 59,5 años (rango: 41-79), 15 son hombres. Los TFA fueron evaluados con: a) historia clínica, b) diario de continencia anal de 21 días, c) escala de continencia anal de Jorge y Wexner, d) manometría anorrectal (MAR) y la CV con el cuestionario de incontinencia fecal (FIQL). Diario de continencia anal: G1: incontinencia fecal (40%) y urgencia defecatoria (45%) vs G2 incontinencia fecal (60%) y urgencia defecatoria (30%) sin diferencias significativas (p = NS). Escala de continencia anal: la incontinencia fecal de G1 fue significativamente menos severa que la de G2 [mediana 6,5 puntos vs 13 puntos; (p = 0,0142)]. MAR: sin diferencias entre los grupos. CV: es significativamente diferente entre ambos grupos (FIQL/G1: 3,7 vs FIQL/G2: 2,8; p < 0,03). La estrategia de seguimiento WW en pacientes con CR localmente avanzado estaría asociada con una mejor CV y menor incontinencia fecal.