Impact of pre- and postoperative multimodality therapy on rectal cancer

Surgery is the primary treatment of rectal cancer. However, variability in surgical outcomes led to development of combined therapies including pelvic radiation and systemic chemotherapy. The evolution of these therapies both individually and combined, their successes and limitations is discussed in the context of an evolving understanding of rectal cancer biology. The impact of standardized optimal surgery on the need for additional therapy and trends in treating complete responders to neoadjuvant therapy is also reviewed.