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Published on: February 12, 2022
Total Neoadjuvant Therapy for the Treatment of Locally Advanced Rectal Cancer
1Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA.
Advances in Surgery
|August 5, 2026
Summary
The treatment for locally advanced rectal cancer has evolved from surgery alone to neoadjuvant therapy, improving outcomes and patient compliance. This shift questions the necessity of surgery in select cases, exploring a total neoadjuvant approach for potential cure.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Rectal cancer treatment evolved significantly over the past century.
- Initial treatment involved surgery, later supplemented by adjuvant chemotherapy and radiation to prevent recurrence.
- Adjuvant therapy aims to reduce local and distant recurrence rates in locally advanced rectal cancer.
Purpose of the Study:
- To explore the historical transition in rectal cancer treatment.
- To examine the benefits of neoadjuvant therapy over adjuvant therapy.
- To discuss the potential of a total neoadjuvant approach and its implications for surgical roles.
Main Methods:
- Review of historical treatment paradigms for locally advanced rectal cancer.
- Analysis of clinical trial data comparing adjuvant and neoadjuvant therapy settings.
- Exploration of oncologic outcomes, patient compliance, and surgical morbidity associated with different treatment strategies.
Main Results:
- Neoadjuvant therapy demonstrated improved oncologic outcomes compared to adjuvant therapy.
- Neoadjuvant approaches led to greater patient compliance with treatment regimens.
- Surgical morbidity remained similar or improved with neoadjuvant therapy compared to adjuvant settings.
Conclusions:
- The shift to neoadjuvant therapy has transformed rectal cancer management.
- A total neoadjuvant approach offers potential for cure in select patients.
- The evolving landscape of rectal cancer treatment challenges the traditional role of surgery.
