Paradigm Shift in the Management of Rectal Cancer

Abstract

Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

Luminal Gastrointestinal Surgery: What Is Round the Corner?

“…The more we know, the less we understand; rectal cancer epitomises this in the GI tract. Evan et al [7] share their vision in terms of the mist of evidence and how it can be translated into individualising it to patients.…”