eP362 - Urogenital Function Following Rectal Cancer Treatment: Watch-and-Wait versus Total Mesorectal Excision

Purpose/Background: Approximately 15-40% of patients with locally advanced rectal cancer will have a clinical complete response to neo-adjuvant treatment with chemoradiation therapy. These patients may then be offered a watch and wait approach (WW) as opposed to operative management which includes total mesorectal excision (TME). Both treatment strategies can impact a patients’ urogenital function, although this seems more defined for patients treated operatively. This study aims to evaluate patient-reported outcomes regarding urogenital function, comparing patients who did not undergo operation (WW) to those that underwent operation (TME).Methods/Interventions: This is a single institution, retrospective review of a prospectively maintained functional database study of patients treated with neoadjuvant chemoradiation therapy for locally advanced rectal cancer between 6/1/2014 and 6/1/2018. Clinical data were collected from the electronic medical record. Functional outcomes to evaluate urogenital function were assessed using gender specific surveys. Women were evaluated using the Urogenital Distress Index-6 (UDI-6), which is scored 0-100 with a score greater than 33 being considered symptomatic. Men were evaluated using the International Prostate Symptom Score (IPSS), which is interpreted as mild (0-7), moderate (8-19), or severe (20-35). Questionnaire scores were acquired at baseline (time of final neoadjuvant treatment), six-month, and three-year timepoints. The cohorts were compared using Kruska-Wallis and Fisher’s exact tests for continuous and categorical variables, respectively.Results/Outcomes: Of 101 patients who underwent neoadjuvant treatment, 17% showed complete clinical response and pursued watch-and-wait while 84% were partial or non-responders and underwent total mesorectal resection. The watch-and-wait group was significantly older (67 vs 54.5 years, p < 0.01 and were more frequently underwent total versus standard neoadjuvant therapy (65% vs 15%, p < 0.01). Urogenital dysfunction for men (IPSS) did not significantly differ between WW and TME cohorts at baseline (9.6 WW vs 4.4 TME, p=0.08), 6 months (4.4 WW vs 7 TME, p=0.37), or 3 years (2.2 WW vs 5.9 TME, p=0.33). Similarly, women in both cohorts reported similar urogenital function via UDI-6 at baseline (16.5 WW vs 26.8 TME, p=0.08), six months (12.1 WW vs 8.1 TME, p=0.56), and three years (6.5 WW vs 8.1 TME, p=0.8). While men reported no significant change over course of treatment, regardless of cohort, women who underwent TME reported significantly worse urogenital function at both 6 months (8.1 vs 26.8, p=0.01) and at 3 years (8.1 vs 26.8, p < 0.01) compared to baseline (Figure).Conclusion/

Discussion: While it is well known that TME can cause urogenital dysfunction, these data suggests that non-operative management with a watch and wait approach is associated with urogenital function scores similar to those seen after TME. Women who underwent surgical resection reported significantly worse urogenital function when compared to their baseline function, however this difference over time may not be clinically significant given that the values still fall within the asymptomatic range of the test. Overall both men and women reported minimal urinary dysfunction, regardless of treatment strategy.Figure. Urogenital function scores over timeWW=watch-and-wait; TME=total mesorectal excision.