Adjuvant Therapy for Rectal Cancer in the Era of Total Mesorectal Excision

CC Law, YT Fu, TM Chan

Hong Kong J Radiol 2006;9:3-14

Total mesorectal excision has recently replaced conventional blunt dissection as the standard treatment for rectal cancer, based on evidence indicating superior treatment outcomes achieved by this procedure. The best known and most emphasised aspect of this treatment is improved pelvic control. However, less information is available on other parameters, including distant control, survival, and functional outcomes such as sphincter preservation and sexual and urinary functions.

This evolution in surgical practice raises a fundamental question: what is the evolving role of adjuvant therapy for rectal cancer in the total mesorectal excision era? To answer this question, this article first evaluates what total mesorectal excision can accomplish in terms of both oncological and functional outcomes, and then investigates prognostic factors, particularly the revived role of circumferential resection margin, in guiding adjuvant treatment selection. Recommendations are made for adjuvant strategy in the total mesorectal excision era in the light of recently reported adjuvant studies.