Rectal Cancer Decision-Making

Abstract

Sound surgical decision-making is essential for optimal management of rectal cancer. It requires a full assessment of the primary tumor, presence of metastases, the patients’ surgical risks, and goals of care. These surgical decisions are often complex and nuanced, and while skills and knowledge are important, it is often a surgical decision that ultimately determines patient outcomes. Most surgical decisions are made preoperatively, but there are intraoperative situations where the surgeon must adapt to unforeseen conditions. In addition, preoperative staging may be inaccurate such that treatment planning must include provisions for alternative strategies should upstaging occur following pathologic review of the surgical specimen. Much like surgical skills, decision-making requires practice with continuous analysis and reflection for improvement.