Surgical Outcomes after Radiotherapy in Rectal Cancer.

Simple Summary: In recent years, there have been significant improvements in the treatment of rectal cancer. Preoperative treatment and surgical techniques have advanced, leading to fewer local recurrences, fewer surgical complications, and more complete resections. Recent trials investigating total neoadjuvant treatment aim to decrease distant metastasis and improve overall survival in patients with locally advanced rectal cancer. In addition, adding chemotherapy to the preoperative treatment increases the complete response rate to 30 to 50 percent of patients. This means that no residual tumour is left and that patients can follow a Watch & Wait surveillance program, potentially avoiding surgery, complications, and colostomy. Nonetheless, many factors have to be considered when deciding on a treatment plan for patients with rectal cancer. Ongoing research aims to identify the optimal treatment regimen, considering factors like tumour stage, toxicity of (neo)adjuvant treatment, and patient preference. Over the past decade, the treatment of rectal cancer has changed considerably. The implementation of TME surgery has, in addition to decreasing the number of local recurrences, improved surgical morbidity and mortality. At the same time, the optimisation of radiotherapy in the preoperative setting has improved oncological outcomes even further, although higher perineal infection rates have been reported. Radiotherapy regimens have evolved through the adjustment of radiotherapy techniques and fields, increased waiting intervals, and, for more advanced tumours, adding chemotherapy. Concurrently, imaging techniques have significantly improved staging accuracy, facilitating more precise selection of advanced tumours. Although chemoradiotherapy does lead to the downsizing and -staging of these tumours, a very clear effect on sphincter-preserving surgery and the negative resection margin has not been proven. Aiming to decrease distant metastasis and improve overall survival for locally advanced rectal cancer, systemic chemotherapy can be added to radiotherapy, known as total neoadjuvant treatment (TNT). High complete response rates, both pathological (pCR) and clinical (cCR), are reported after TNT. Patients who follow a Watch & Wait program after a cCR can potentially avoid surgical morbidity and colostomy. For both early and more advanced tumours, trials are now investigating optimal regimens in an attempt to offer organ preservation as much as possible. Multidisciplinary deliberation should include patient preference, treatment toxicity, and likelihood of end colostomy, but also the burden of intensive surveillance in a W&W program. [ABSTRACT FROM AUTHOR]