Abstract
The oncological results for patients with early localized rectal cancer treated with radiation and chemotherapy (CRT) (with or without local excision), who achieve a complete clinical response (cCR) appear to be similar to conventional total mesorectal excision (TME) from the data presently available. As such, patients with a clinical complete cCR to CRT are increasingly being closely followed up with a watchandwait strategy in order to achieve organ preservation (OP). The question therefore arises that if survival is the same for patients undergoing surgery with total TME as for OP, then which model of treatment leads to the best quality of life (QoL)? To date, few studies have looked at this aspect in patients treated with OP, and the early data require careful interpretation, against a backdrop of previous trials investigating radiotherapy as an adjunct to surgery for rectal cancer. The avoidance of major pelvic surgery and the risks of complications that entail, with the common use of a temporary stoma and, in some cases, a permanent stoma, might be enough for OP to be considered clearly to provide a better QoL. However, when the OP pathway is used for early rectal cancer, many patients receive CRT who might have avoided CRT and just had TME alone, and as such are exposed to the cost, complications, and longterm damaging effects of CRT, which may impact QoL.