| Clinical management of locally advanced rectal cancer (LARC) has rapidly evolved over the past 30 years, including improved staging; implementation of modern multimodality therapy consisting of chemotherapy, radiation and surgery; and minimally invasive surgery (MIS). The emergence of adjuvant chemoradiotherapy in the 1980s followed by the adoption of neoadjuvant chemoradiotherapy (chemoRT), along with refinement in surgical technique, have markedly reduced local recurrence. Improved staging with MRI has assisted in patient selection for neoadjuvant therapy and facilitated preoperative planning to achieve complete margin‐negative resection. MIS and associated enhanced recovery programs have accelerated postoperative recovery and further reduced treatment‐related morbidity. Currently, distant metastases remain the greatest risk for rectal cancer patients. Total neoadjuvant therapy (TNT) is aimed at early treatment of possible distant micrometastatic disease by delivering the full course of prescribed systemic chemotherapy in addition to standard chemoRT before surgery. In this presentation, studies supporting neoadjuvant therapy for LARC will be reviewed, including recent studies on total neoadjuvant therapy, along with robotic surgery and nonoperative management of locally advanced rectal cancer. |
