[Multidisciplinary integrated treatment of locally advanced and recurrent rectal cancer]

The treatment of locally advanced (LARC) and locally recurrent (LRRC) rectal cancers poses significant challenges due to the anatomical complexity and the aggressive nature of tumor invasion. The adoption of multidisciplinary team (MDT) treatment models has become key to improving patient outcomes. Within the MDT framework, advances in imaging and pathology facilitate accurate assessment of disease. In minimally invasive surgery, urinary system reconstruction and pelvic floor reconstruction techniques have significantly improved outcomes for patients undergoing surgery. MDT decision-making plays a particularly important role in the selection of neoadjuvant treatment strategies: The MDT must weigh up the benefits and risks while taking into account the patient's primary disease, as well as their physical and mental condition, and strictly adhere to the indications for pelvic exenteration (PE) surgery. For patients without mesorectal involvement, neoadjuvant chemotherapy alone has demonstrated comparable efficacy to neoadjuvant chemoradiotherapy while exhibiting lower toxicity, but its application in T4b patients requires further validation. In conclusion, the treatment of LARC/LRRC has entered the era of multidisciplinary precision, and the MDT model is the core mechanism for integrating technological innovation and evidence to continuously improve patients' survival and quality of life. The future direction of development under the MDT model focuses on the integration of imaging and liquid biopsy for precise stratification, the optimization of the cost of robotic surgery and the innovation of bioprosthetic materials, the clarification of the optimal preoperative plan through multicenter studies, and exploring immune-based/targeted combination strategies.