New Horizons in Rectal Cancer Management in Colon and Rectal Surgery

Many practicing surgeons remember a time when the treatment of rectal cancer was straightforward. Preoperative assessment of the tumor required only an “educated” finger and a proctoscope. Except for very early tumors, radical resection using an open approach was performed. Radiation therapy was of disputable benefit and chemotherapy ineffective. Organ preservation and avoidance of bowel and sexual dysfunction were secondary concerns.

Times have indeed changed, and the advances have been breathtaking. The treatment of rectal cancer is no longer solely in the hands of the surgeon, and the benefits of a multidisciplinary approach have become obvious. Consider the following advances: remarkable accurate imaging that can be used to dictate a rational therapeutic plan; a standardized anatomic surgery that has dramatically reduced local recurrence rates, and multiple platforms and techniques with which to accomplish that surgery; new surgical and endoscopic approaches to local therapy; new techniques to allow sphincter preservation in even lower tumors; modern chemo- and radiation therapies that reduce the risk of local recurrence, increase the rate of pathologic complete responses, and provide effective treatment for recurrent cancers; and a sound anatomic approach to local advanced and recurrent tumors that offers a real hope of cure in appropriately selected cases. Even more surprising to surgical traditionalists is the concept of nonsurgical therapy for patients who achieve complete clinical responses, an approach that has steadily gained international acceptance under its “watch and wait” moniker. Finally, advances in our understanding of the molecular mechanisms or colorectal cancer hold the real promise of novel therapeutics and personalized therapy for patients with rectal cancer.

In this issue of Clinics in Colon & Rectal Surgery, Dr. Rodrigo Oliva Perez has assembled an outstanding roster of world experts to bring the reader up to date in these many exciting developments. This is mandatory reading for anyone seeking the latest word in advanced rectal cancer therapy. Traditionalists beware: the future is now!