Multimodale Therapie des Rektumkarzinoms

Treatment strategies for rectal cancer have changed considerably during the past two decades. This particularly relates to locally advanced cancers of the middle and lower rectum, where high-resolution MRI is of prime importance for treatment planning. Surgical resection of the primary tumor with oncological lymphadenectomy continues to play a central role in multimodal treatment concepts. In this respect, the results of minimally invasive techniques (laparoscopy and robotic-assisted surgery) and open surgical resection are similar. Recent developments include, in particular, the concept of total neoadjuvant therapy, in which neoadjuvant chemoradiotherapy or radiotherapy is complemented by an additional neoadjuvant chemotherapy, as well as the concept of organ-preserving watch-and-wait strategy, in which patients with complete clinical remission after neoadjuvant treatment are spared from radical surgical resection.