Modern surgical strategy in patients with rectal cancer with emphasis on the influence of radiotherapy on it

Medical Review (Med. pregled), 2024, 60(2), 5-15.

Zh. Shavalov, E. Arabadzhieva, L. Simonova, A. Yonkov

Department of General and Hepato-pancreatic Surgery, University Hospital “Alexandrovska”, Medical University – Sofia

Abstract. Rectal carcinoma is the third most common malignancy worldwide. This review aims to present the development and the achieved results in its treatment, emphasizing the surgical strategy and the place of radiotherapy, paying attention to the current challenges and future perspectives. The review was prepared by a thorough search in PubMed/MEDLINE, EMBASE and Google Scholar using key words: “rectal carcinoma”, “radiotherapy”, “chemotherapy”, “trimodal therapy”, “neoadjuvant radiation-chemotherapy”, “mesorectal excision”, which was not restricted by a language. In recent years, the diagnosis and treatment of patients with rectal cancer have significantly evolved. The progress of the surgical technique, the introduction of preoperative chemoradiotherapy, and the optimization of the period for performing a surgical procedure led to a significantly decreased risk of local recurrence and the development of distant metastases, and an increase in survival. The different therapeutic response to neoadjuvant chemoradiotherapy influences the type of subsequent surgery or the adoption of a “wait-and-watch” strategy. Therefore, more problems related to accurate preoperative staging, selection of an appropriate regimen of neoadjuvant chemoradiotherapy and the possibility of predicting sensitivity to it must be clarified. This would be the basis for achieving individualized and minimized but effective treatment with possible flexibility to adapt with frequent response reassessments.

Key words: rectal carcinoma, neoadjuvant radiotherapy, rectal resection, survival, local recurrence

Address for correspondence: Elena Arabadzhieva, MD, PhD, e-mail: elena_arabadjieva@abv.bg