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Objective To evaluate functional outcomes and quality of life (QOL) associated with `wait-and-watch’ (WW) strategy and local-excision (LE) of rectal tumours after neo-adjuvant therapy, in comparison to the standard practice of total-mesorectal-excision (TME) for locally-advanced-rectal-cancers. Data Sources Medline, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, and retrospective studies with propensity-score-matched analyses analysing outcomes of WW and LE procedures for rectal cancer. Data Extraction and Synthesis Risk of bias assessments and data extraction were carried out independently by two reviewers. A narrative synthesis of data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The outcomes of interest were those of faecal-incontinence (FI), bowel and rectal-evacuatory function, sexual-function, stoma-free-survival, and quality-of-life scores, which were assessed in comparison to those associated with radical surgeries. Results 7 studies reported functional outcomes. Faecal-incontinence, bowel, and rectal-evacuatory-function assessed by various scoring systems were found to be least affected among patients on WW strategy, followed by those undergoing local excision and most in patients undergoing TME. These reflected on the quality of life assessments (FIQOL and FACT-C questionnaires). Sexual dysfunction was not higher among patients who underwent LE compared to TME. Advantage of stoma-free-survival with organ preservation strategies was realised for up to 2 years after treatment. Conclusions Organ-preservation strategies appear to have a favourable functional outcome compared to the gold standard of TME for up to 2 years after the commencement of treatment. Further research is warranted to provide stronger levels of evidence regarding the same.

british journal of surgery

TP1.2.6Functional Outcomes of Organ Preservation Strategies - Local Excision Procedures and 'Watchful-Waiting' In Management of Low Rectal Cancers - A Systematic Review