Management of rectal cancer: strategies and controversies

Colorectal cancer is one of the most common cancers in the western world. The goal of this review is to outline some of the important surgical issues surrounding the management of rectal cancer. In patients with early rectal cancer (T1), local excision may be an alternative approach in highly selected patients. For more advanced rectal cancer, radical surgical resection is the treatment of choice. Total mesorectal excision and negative radial margin (>1 mm) decreases the local recurrence rate and improves survival. In appropriate patients, laparoscopic resection allows for improved patient comfort, shorter hospital stays, and earlier returns to preoperative activity level. In patients with locally advanced disease, neoadjuvant chemoradiotherapy followed by radical excision according to the principles of TME has become widely accepted. Surgical resection is the treatment of choice for resectable liver metastasis of colorectal origin. Surgical resection improves disease-free and overall survival rate. For patients with unresectable metastatic disease, multimodality approach may increase the resectability rate and hence survival.