Current paradigms in rectal cancer

Rectal cancer is one of the leading causes of morbidity and mortality in the world. It is more common in Western nations than eastern nations (except Korea). Because of its location rectal cancer is unique in its presentation and natural history. The decision-making in the treatment of rectal cancer is not as straight forward as colon cancer. It requires an in depth understanding of the anatomy and knowledge of tumor biology to formulate a successful rectal cancer management plan. Often training in the field of colorectal surgery has been shown to have better patient outcomes. Also with the advent of newer methods of treatment like TAMIS and Ta TME and not to forget laparoscopy and robotics has made the treatment of rectal cancer more exciting. It is often challenging for the physician to decide whether to offer a neoadjuvant chemo radiation to the patient or surgery as first option. In these scenarios multidisciplinary tumor board meetings go a long way in helping evidence based decision-making. Now a days the surgeon treating rectal cancer should be familiar with more than one method of doing an operation. A hybrid approach where a surgeon can combine lap/open/robotics/TAMIS or Ta TME seems to be the way forward.