[Confirmed preoperative therapy of rectal carcinoma]

Optimized surgical management is the most important factor influencing prognosis of patients suffering for rectal carcinoma. Oncologically radical surgical procedures with the intent of histologically complete resection should be performed, including excision of the tumour in total with sufficient margins in the oral and aboral directions. Total excision of the mesorectal tissue, at least in low-lying rectal tumours, is strongly recommended. Several retro- and prospective studies show that the surgeon him- or herself, using these adequate techniques, is the most important, statistically significant independent prognostic factor in patients with rectal carcinoma. In addition, adjuvant radiochemotherapy, given before or after surgery, decreases the local failure rates of high-risk patients (UICC stages II and III). Such radiochemotherapy is, to the great variety of different local failure rates in different surgical departments mandatory as recommended by the consensus conference of the German Cancer Society in July 1999. New and improved radiation techniques (conformal radiotherapy, intraoperative radiotherapy) could significantly decrease therapy-related toxicity, and innovative schedules (continuous low-dose 5-FU) may show increased therapeutic benefit of adjuvant treatment. Combined radiochemotherapy prior to surgery seems to increase the rate of sphincter-preserving procedures in low-lying rectal cancer. Definitive results and a clear advantage of pre- over postoperative radiochemotherapy (currently being tested in a German multicenter study) are still pending.