Optimal timing of surgery after preoperative chemoradiotherapy for rectal cancer

The timing of surgery in rectal cancer treatment after neoadjuvant chemoradiotherapy is debated, mainly because of downsizing and repopulation of tumor cells. The retrospective analysis of prospectively collected data from a series of patients with locally advanced rectal cancer by Lim et al. has tried to evaluate whether timing of surgery after neoadjuvant chemoradiotherapy has any effect on tumor regression, sphincter preservation, local recurrence rate or overall survival. The study included 397 patients who had received chemoradiotherapy and surgery with different time intervals between the use of these modalities. No differences regarding all four parameters were found in patients with a time interval less or greater than 41 days. Some methodological reasons can be discussed, but the only way to answer the question of timing is, of course, to do a randomized trial.