Prognosis and Quality of Life Analysis After Neoadjuvant Chemoradiotherapy and Primary Surgery for Low-lying Locally Advanced Rectal Cancer: Can Patients Benefit From Neoadjuvant Therapy?

Background: Neoadjuvant Chemoradiotherapy (nCRT) is a widely accepted regimen for patients with locally advanced rectal cancer (LARC). This compared the long-term prognosis and postoperative quality of life (QoL) between patients with low-lying LARC receiving nCRT and primary surgery.MethodPatients underwent nCRT or primary surgery for low-lying LARC between 2010 and 2016 were identified. Five-year local recurrence (LR) and disease free survival (DFS) were compared between groups. Quality of life (QoL) of patients who were disease-free was investigated using European Organization for Research and Treatment of Cancer QoL questionnaire core-30 (EORTC QLQ-C30) and QLQ-Colorectal Cancer module (CR29).ResultsA total of 304 patients were included in this study. Differences in 5-year LR and DFS between groups showed no statistical significance. In terms of QoL, apart from less stoma care problem, nCRT patients showed unsatisfactory social function and worse symptoms including diarrhoea, financial difficulties, buttock pain, fecal incontinence, embarrassment and impotence compared with primary surgery group. Intergroup analysis indicated that the QoL of patients receiving nCRT with preserved sphincter was relatively inferior compared with other subgroups, as reflected in higher symptom scores including financial difficulties and those related to low anterior resection syndrome (LARS) such as diarrhea, stool frequency, flatulence and fecal incontinence.ConclusionFor patients with low-lying LARC, nCRT has no advantage in terms of 5-year survival and QoL. NCRT with sphincter preserving surgery should be conducted meticulously considering its limited benefits for patients.