Treatment of rectal cancer--a critical update

The treatment of rectal cancer still remains primarily surgical in nature. Techniques have evolved from complete extirpation of the rectum and anal canal which left the patient with a permanent colostomy, to sphincter-saving procedures. Effort is now concentrated on reducing local recurrence by combining total mesorectal excision with adjuvant radiotherapy and there is good evidence that both are effective. However, it is likely that only adjuvant chemotherapy will improve survival, and numerous studies are currently in progress to determine the best combination of drugs. In addition, attempts are being made to improve the functional results of sphincter-saving surgery, most notably by the addition of a colonic pouch to the procedure.