Approach to rectal cancer surgery.

Area of Science:

• Gastroenterology and Surgical Oncology
• Colorectal Surgery

Background:

• Rectal cancer requires specialized management distinct from other colorectal cancers.
• Significant progress has been made in surgical approaches across all disease stages.

Purpose of the Study:

• To summarize recent surgical developments in rectal cancer management.
• To highlight advancements in local excision, total mesorectal excision, and laparoscopic techniques.
• To review strategies for locally advanced, metastatic, and peritoneal disease.

Main Methods:

• Review of current literature on rectal cancer surgery.
• Analysis of advancements in neoadjuvant and adjuvant therapies.
• Evaluation of minimally invasive surgical techniques, including laparoscopy.
• Assessment of surgical options for metastatic and peritoneal disease.

Main Results:

• Local excision strategies are effective for preinvasive and early rectal cancers.
• Standardized total mesorectal excision (TME) with neoadjuvant chemoradiation improves outcomes for resectable cancers.
• Laparoscopic surgery is becoming the standard approach for rectal cancer.
• Multimodality treatment combining chemoradiation and radical surgery offers disease control for advanced/metastatic disease.
• Resection of liver and lung metastases is well-documented.
• Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy shows promise for peritoneal metastases.

Conclusions:

• Rectal cancer surgery has evolved with the integration of local excision, standardized TME, and laparoscopic techniques.
• Multimodality treatment and surgical resection of metastases are crucial for managing advanced and metastatic rectal cancer.
• Emerging therapies like cytoreductive surgery offer new hope for peritoneal disease control.