title: Preoperative decision making for rectal cancer.
abstract: BACKGROUND
  Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients.
  
  
  METHODS
  We searched the MEDLINE and PubMed databases using the following keywords: "rectal cancer," "total mesorectal excision," "multidisciplinary treatment/team," "radiotherapy," "chemotherapy," and their combinations. There were no language or publication year restrictions. References in published articles also were reviewed.
  
  
  RESULTS
  Total mesorectal excision surgery, high-resolution pelvic magnetic resonance imaging, preoperative chemoradiotherapy, and pathologic reports according to Quirke protocol are preconditions for the initiation of an effective multidisciplinary team. Common topics for discussion are the status of the circumferential margin, the type of radiotherapy and surgery required, and the chemotherapeutic agent to be used.
  
  
  CONCLUSIONS
  This review focuses on this issue based on two main principles. First, the status of the circumferential margin dictates the use of preoperative chemoradiotherapy. Second, preoperative chemoradiotherapy is superior in terms of free circumferential resection margin rate, local recurrence rate, and toxicity.
authors.affiliation: Department of Surgery, Venizeleio Hospital, Herakleion, Greece. taflampas2003@yahoo.gr
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Taflampas
authors.forename: Manousos
authors.initials: M
authors.lastname: Christodoulakis
authors.forename: Eelco
authors.initials: E
authors.lastname: de Bree
authors.forename: John
authors.initials: J
authors.lastname: Melissas
authors.forename: Dimitris D A
authors.initials: DD
authors.lastname: Tsiftsis
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003657:Decision Making; D003952:Diagnostic Imaging; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010348:Patient Care Team / Q000458:organization & administration*; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*