Rectal cancer treatment has evolved during the past 40 years with the use of a standardized surgical technique for tumour resection: total mesorectal excision. A dramatic reduction in local recurrence rates and improved survival outcomes have been achieved as consequences of a better understanding of the surgical oncology of rectal cancer, and the advent of adjuvant and neoadjuvant treatments to compliment surgery have paved the way for a multidisciplinary approach to disease management. Further improvements in imaging techniques and the ability to identify prognostic factors such as tumour regression, extramural venous invasion and threatened margins have introduced the concept of decision-making based on preoperative staging information. Modern treatment strategies are underpinned by accurate high-resolution imaging guiding both neoadjuvant therapy and precision surgery, followed by meticulous pathological scrutiny identifying the important prognostic factors for adjuvant chemotherapy. Included in these strategies are organ-sparing approaches and watch-and-wait strategies in selected patients. These pathways rely on the close working of interlinked disciplines within a multidisciplinary team. Such multidisciplinary forums are becoming standard in the treatment of rectal cancer across the UK, Europe and, more recently, the USA. This Review examines the essential components of modern-day management of rectal cancer through a multidisciplinary team approach, providing information that is essential for any practising colorectal surgeon to guide the best patient care.
As rectal cancer treatment becomes more precise, high-resolution imaging techniques have been established to identify the important tumour characteristics that help guide management.
High-resolution MRI scans are increasingly dictating treatment strategies by providing predictive and prognostic information related to the tumour, and are a standard part of the patient investigation pathway.
Surgical management depends on patient and tumour factors with an aim to optimize function and survival with the lowest risk of recurrence.
Multiple approaches are currently available for resection, including radical surgery involving excision of the rectum and associated mesentery as well as organ-sparing techniques involving local excision of the lesion, or deferring surgery altogether.
The pathological assessment of the resected rectal cancer specimen provides a level of quality control ensuring that surgical principles have been adhered to and that the surgery was performed in an optimal oncological manner.
Multidisciplinary team presentation of imaging data, evidence-based oncological, surgical and functional recommendations, and pathological assessment of surgical quality are essential components of formalized cancer care.
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The authors declare no competing interests.
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Keller, D.S., Berho, M., Perez, R.O. et al. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol 17, 414–429 (2020). https://doi.org/10.1038/s41575-020-0275-y
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