Rectal cancer: current surgical management

Abstract

Since the description of the abdominoperineal resection by W. Ernest Miles in 1908 and total mesorectal excision by Heald et al. in 1982, rectal cancer surgery continues to evolve. This evolution has not been limited to the surgical front. State-of-the-art imaging techniques allow us to stage more accurately the disease and modify our management accordingly. Advances in radiotherapy and chemotherapy have not only reduced local recurrence and improved survival rates in rectal cancer, but are also changing our surgical algorithm in approaching the disease. To achieve the best results, it is crucial to approach rectal cancer in a multidisciplinary fashion involving high volume surgeons, radiation and medical oncologists, radiologists, stoma therapists, and trained nurses in colorectal cancer care. Despite a low operative mortality, it is important to customize the approach to rectal cancer according to the patient's quality of life and life expectancy. This review will focus on current surgical management of rectal cancer and some of the newer advances in rectal cancer management.