Widening role of multidisciplinary treatment for rectal cancer: toward diversity of cancer care

Abstract

Advances in treatment modalities, including systemic therapy, local therapy, and technical development, have substantially improved survival rates in patients with colorectal cancer [1]. In addition, the rate of colorectal cancer diagnosis before 50 years of age has been increasing over the past two decades [2]. The number of cancer survivors who suffer from chronic morbidities that impair their quality of life has also increased and will continue growing. Therefore, precision medicine in the era of rectal cancer management aims to provide curative-intent treatment based on tumor characteristics and preserve the quality of life, especially bowel function with sphincter preservation or rectum sparing. Functional derangement was considerably significant after radical resection of rectal cancer. Abdominoperineal resection results in a colossal lifestyle change, and surgeons have attempted to preserve the sphincter. However, several patients experience bowel dysfunction even after sphincter preservation, which constitutes a series of symptoms. Although researchers have suggested various methods for evaluating and managing bowel dysfunction after rectal cancer surgery, treatment strategies need to be established. Therefore, endoscopic removal or local excision has been widely accepted for early rectal cancer treatment, as oncologic outcomes are comparable to those after radical resection. Even in patients with advanced rectal cancer, neoadjuvant chemoradiotherapy resulted in complete tumor regression in a subset of patients, which led us to consider deferral surgery. Watch-andwait (WW) strategies have continuously gained approval in the Asia-Pacific region and Western countries [3]. Proper patient selection is critical for the organ-preserving strategies mentioned above. In this issue of Precision and Future Medicine, three review articles have been published on rectal cancer management, in which interest has increased. Park and Baik [4] reviewed functional assessment methods and various treatments for bowel dysfunction. A series of symptoms associated with postoperative bowel dysfunction was typically called “low anterior resection syndrome (LARS).” Although different scoring systems have been proposed, each affords advantages and drawbacks. The LARS score questionnaire is a widely used tool. Young age, low anastomosis level, anastomotic leakage, and radiotherapy were related to the occurrence of LARS. Medical management, pelvic floor rehabilitation, and sacral nerve stimulation have been suggested for treating LARS. The authors also documented urinary and sexual dysfunctions, as reported in 20% to 40% of patients who undergo rectal cancer surgery. The authors concluded that surgeons should carefully perform sphincter-preserving rectal cancer surgery to ensure functional recovery of the remnant bowel and improve urologic and sexual Received: December 22, 2021 Revised: December 24, 2021 Accepted: December 24, 2021