Preoperative decision making for rectal cancer.
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.
Taflampas
Panagiotis
P
Department of Surgery, Venizeleio Hospital, Herakleion, Greece. taflampas2003@yahoo.gr
Christodoulakis
Manousos
M
de Bree
Eelco
E
Melissas
John
J
Tsiftsis
Dimitris D A
DD
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*