Functional outcomes in rectal cancer patients treated with immunotherapy and neoadjuvant therapy: a retrospective analysis.

Objective: This study aims to evaluate bowel and urogenital function in patients with locally advanced low rectal cancer treated with immunotherapy combined with neoadjuvant therapy followed by surgery, compared to surgery alone.

Methods: We conducted a retrospective analysis of 162 patients with locally advanced low rectal cancer treated at Union Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, from May 2021 to May 2024. Seventy-three patients underwent short-course radiotherapy combined with chemotherapy and immunotherapy followed by surgery (SCRT-CIT group), while 89 patients received surgery alone (non-SCRT-CIT group). Standardized questionnaires assessed bowel and urogenital function. Logistic regression analysis was used to identify independent predictors of functional outcomes.

Results: The incidence of major low anterior resection syndrome (LARS) was significantly higher in the SCRT-CIT group (59.0%) compared to the non-SCRT-CIT group (9.2%). Multivariate analysis identified SCRT-CIT as an independent risk factor for bowel dysfunction (odds ratio [OR] = 10.45, 95% confidence interval [CI], 4.63 ~ 23.57, P < 0.001). SCRT-CIT was also associated with an increased risk of erectile dysfunction in men (OR = 6.51, 95% CI, 1.90 ~ 22.35, P = 0.003) and reduced sexual duration (P = 0.003). In women, SCRT-CIT correlated with a higher prevalence of dyspareunia (P = 0.004) and reduced sexual satisfaction (P = 0.003).

Conclusion: SCRT-CIT combined with surgery is associated with a significantly higher risk of bowel dysfunction, male erectile dysfunction, reduced sexual duration, and female sexual impairments, including dyspareunia and diminished sexual satisfaction. These findings underscore the importance of comprehensive functional assessments and individualized management for patients undergoing SCRT-CIT for locally advanced low rectal cancer.