Current Surgical Strategies in the Management of Rectal Cancer

  • José Moreira de Azevedo
  • Bruna Borba Vailati
  • Guilherme Pagin São Julião
  • Laura Melina Fernandez
  • Rodrigo Oliva PerezEmail author
Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer


Purpose of Review

The surgical approach to rectal cancer has become significantly more complex with the introduction of neoadjuvant therapies and organ preservation strategies. Optimal radiological imaging in association with relevant clinical findings provides critical information for final surgical management decision. The present review focuses on the surgical alternatives available in different clinical scenarios for the management of rectal cancer.

Recent Findings

Most of evidence for surgical management of rectal cancer is provided by non-randomized studies. However, a few randomized clinical trials have attempted to address the optimal surgical approach for total mesorectal excision. In addition, recent randomized trials have also contributed to the understanding of the role of organ-preserving strategies among patients with excellent response to neoadjuvant treatment. Finally, one randomized Japanese study has provided oncological evidence in favor of prophylactic lateral node dissection among these patients.


Radical proctectomy with total or partial mesorectal excision is the standard procedure for most patients with primary rectal cancer. Optimal approach for this procedure remains controversial. The decision between sphincter-preservation strategies and abdominal perineal resections should take into account the radiological and clinical findings. More recently, organ-preserving strategies including transanal local excisions may be used in select patients with early-stage disease or among patients undergoing neoadjuvant treatment strategies after significant primary tumor regression. Extended procedures including lateral pelvic side lymphadenectomies and exenterative procedures should be done selectively and in highly specialized centers.


Rectal cancer Total mesorectal excision Neoadjuvant chemoradiation Laparoscopic surgery Robotic surgery Local excision Watch and wait Lateral lymph node dissection 


Compliance With Ethical Standards

Conflict of Interest

José Moreira de Azevedo declares that he has no conflict of interest.

Bruna Borba Vailati has received compensation from Johnson & Johnson and Medtronic for Service as a consultant.

Guilherme Pagin São Julião has received compensation from Johnson & Johnson and Medtronic for Service as a consultant.

Laura Melina Fernandez declares that she has no conflict of interest.

Rodrigo Oliva Perez has received compensation from Johnson & Johnson and Medtronic for Service as a consultant.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • José Moreira de Azevedo
    • 1
  • Bruna Borba Vailati
    • 1
  • Guilherme Pagin São Julião
    • 1
  • Laura Melina Fernandez
    • 2
  • Rodrigo Oliva Perez
    • 1
    Email author
  1. 1.Angelita & Joaquim Gama InstituteSão PauloBrazil
  2. 2.Champalimaud FoundationLisbonPortugal

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