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F1000Res. 2018 Nov 29;7. pii: F1000 Faculty Rev-1868. doi: 10.12688/f1000research.16194.1. eCollection 2018.

Novelties in treatment of locally advanced rectal cancer.

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Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.


Treatment of locally advanced rectal cancer is evolving through surgical innovation and paradigm shifts in neoadjuvant treatment. Whereas local recurrence was a significant concern before the systematic implementation of neoadjuvant chemoradiation therapy and surgery according to total mesorectal excision principles, distant relapse remains a major drawback. Hence, efforts in recent years have focused on delivering preoperative chemotherapy regimens to overcome compliance issues with adjuvant administration. In parallel, new surgical techniques, including transanal video-assisted total mesorectal excision and robot-assisted surgery, emerged to face the challenge to navigate in the deep and narrow spaces of the pelvis. Furthermore, patients experiencing a complete response after neoadjuvant treatment might even escape surgery within a close surveillance strategy. This novel "watch and wait" concept has gained interest to improve quality of life in highly selected patients. This review summarizes recent evidence and controversies and provides an overview on timely and innovative aspects in the treatment of locally advanced rectal cancer.


Rectal cancer; neoadjuvant; surgery; treatment; watch and wait

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

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