Rectal cancer--adequacy of surgical management

Rectal carcinoma remains a common, lethal form of malignancy. Despite improvement in overall survival due to increased resectability, decreased operative mortality, and possibly earlier detection at a more favorable stage, the cancer-specific survival rate stage for stage following operative treatment is unchanged in recent decades. Overall survival rate should increase further if earlier diagnosis can be made at a time when all lesions are locally confined and resectable for cure and if operative mortality can consistently be kept under 2 percent. The latter will require not only improvement in surgeons' skills to conduct these operations efficiently but also, and perhaps more important, improvement in surgeon's abilities to better select which patients can and should safely undergo a major resection. Improvement in cancer-specific survival rate stage for stage is not likely to result from operative methods but probably depends upon development of effective forms of adjuvant therapy or of totally new forms of therapy designed to supplement or supplant operative intervention. At present, it is discouraging that no such development has occurred, though radiation therapy may prove useful.