BACKGROUND Despite advances in treatment of primary colon cancer, approximately 5 to 10% of patients will develop a locoregional recurrence of colon cancer. Early recurrences diagnosed within 1 year have been associated with worse outcomes, but evidence is limited and conflicting. OBJECTIVE This study aimed to evaluate the prognostic impact of timing of locoregional recurrence detection. DESIGN This is a cross-sectional multicenter cohort study. SETTINGS Multicenter collaborative study involving 50 Dutch hospitals. PATIENTS Patients with locoregional recurrence after colon cancer resection between January 2014 and December 2015, stratified by timing of locoregional recurrence diagnosis (early < 1 year, late ≥ 1 year). MAIN OUTCOME MEASURES Overall survival stratified by treatment intent. RESULTS Among 9,523 patients, 676 (7.1%) developed locoregional recurrence (291 early, 385 late). Median time to locoregional recurrence diagnosis was 13.7 months (IQR 8.6-23.4). Late diagnosis of locoregional recurrence was independently associated with higher probability of overall survival (median 18.0 vs 9.1 months; HR 0.83, 95% CI 0.69-0.99) and was more often treated with curative intent (34.6 vs 24.0%, p = 0.01). In patients treated with curative intent, overall survival did not differ between early and late locoregional recurrence (median 40.1 vs 40.7 months; HR 1.05, 95% CI 0.73-1.51, p = 0.79). In palliatively treated patients, late locoregional recurrence was associated with longer overall survival compared to early locoregional recurrence (median 10.1 vs 6.8months; HR 0.70, 95% CI 0.58-0.84, p < 0.001). LIMITATIONS This study is limited by its retrospective design. CONCLUSIONS Late diagnosis of locoregional recurrence was associated with better survival, but survival from the moment of locoregional recurrence was not different between patients with early and late recurrences who were treated with curative intent. See Video Abstract.
BACKGROUND Watch-and-wait has allowed organ preservation in patients with locally advanced rectal cancer who have a clinical complete response to neoadjuvant therapy. The expansion of non-operative management to patients with a near-complete response raises the question of oncological safety in a nonoperative approach in this subset of patients. OBJECTIVE We aimed to assess the prognostic impact of clinical response after neoadjuvant therapy and to assess the oncologic safety of nonoperative management in patients with near-complete or complete clinical responses. DATA SOURCES We systematically reviewed PubMed, Embase and Web of Science in October 2025 to identify studies comparing oncological outcomes of patients with clinical or near-complete response. STUDY SELECTION Studies comparing clinical response after neoadjuvant therapy in patients with locally advanced rectal cancer were included. We excluded conference abstracts. MAIN OUTCOME MEASURES Primary outcome was overall survival. Secondary outcomes included distant metastasis, local regrowth, local regrowth-free survival, and organ preservation rate. RESULTS We included 10 studies and 1,763 patients. Near-complete response after neoadjuvant therapy for rectal cancer is associated with higher risk of distant metastasis (16.8 vs 7.3%; RR 2.31; 95% CI: 1.63-3.26; p < 0.001; I² = 0%), and local regrowth (32.8 vs 19.7%; RR 1.75; 95% CI: 1.31-2.34; p < 0.001; I² = 42%), as well as reduced organ preservation (73.5 vs 80.7%; RR 0.84; 95% CI: 0.74-0.95; p = 0.007; I² = 69%) compared with clinical complete response. No statistical differences were seen in overall survival (HR 1.43; 95% CI: 0.94-2.16; p = 0.076; I² = 0%). LIMITATIONS Heterogeneous definitions of near-complete response and lack of standardized reassessment timing and management. CONCLUSION In contrast to individual studies, we found that near-complete response after neoadjuvant therapy may have an increased risk of distant metastasis compared to patients with a complete clinical response.
BACKGROUND Up to 80% of patients who undergo rectal resection suffer from low anterior resection syndrome, with approximately half continuing to experience symptoms more than 10 years after surgery. While short-term outcomes are well documented, evidence on long-term functional and health-related quality of life trajectories remains fragmented. There is some improvement over time, but symptoms often persist. OBJECTIVE To systematically review the prevalence, severity, and long-term trajectory of low anterior resection syndrome, and its association with health-related quality of life, in rectal cancer survivors followed for at least five years after sphincter-preserving surgery. DATA SOURCES A systematic search of PubMed, Scopus, and the Cochrane Library from inception through September 2025. STUDY SELECTION Eligible studies reported low anterior resection syndrome scores in patients at ≥5 years following sphincter-preserving rectal cancer resection. Studies lacking long-term functional assessment or not reporting low anterior resection syndrome were excluded. INTERVENTIONS None; all included studies comprised observational cohort data assessing long-term functional outcomes. MAIN OUTCOME MEASURES Prevalence of major and minor Low Anterior Resection Syndrome, distribution of long-term low anterior resection syndrome severity categories, and associations between low anterior resection syndrome severity and health-related quality of life measures. RESULTS Six studies comprising 1,000 patients were included, with median follow-up ranging from 6.9 to 14.6 years. Across cohorts, major low anterior resection syndrome was reported in 20.5-53.0% of patients and minor low anterior resection syndrome in 14.6-27.0%. Overall, 39.3% of patients experienced major low anterior resection syndrome, 21.5% minor low anterior resection syndrome, and 39.2% reported no low anterior resection syndrome at long-term follow-up. Major low anterior resection syndrome was consistently associated with significant health-related quality of life impairment across multiple domains. Neoadjuvant radiotherapy emerged as the most consistent risk factor for persistent bowel dysfunction. LIMITATIONS Heterogeneity in neoadjuvant radiotherapy, tumor height, and exclusion of patients with permanent or secondary stomas; observational designs. CONCLUSION Nearly half of rectal cancer survivors experience major Low Anterior Resection Syndrome ≥5 years postoperatively, highlighting the persistence of bowel dysfunction and its lasting impact on health-related quality of life. These findings underscore the need for long-term survivorship care and functional outcome monitoring.
