Optimal timing of surgery for locally advance rectal cancer: how we choose

Abstract

Locally advanced rectal cancer (LARC) is associated with a high risk of local recurrence and distant metastasis, making it difficult to be cured by surgery alone. Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for LARC, with reduced local recurrence rates. However, neoadjuvant chemoradiotherapy is associated with patients' urogenital and sexual dysfunction, which severely affecting their quality of life. Therefore, determining the optimal timing of surgery to balance oncologic and functional outcomes is crucial and challenging. We proposed that choosing the optimal timing of surgery based on preoperative risk assessment of LARC is an effective strategy. The patients with low to moderate risk of recurrence can be considered to perform surgery directly or have preoperative chemotherapy followed by radical surgery. Patients with high risk of recurrence should extend neoadjuvant therapy before surgery to improve oncologic outcomes. In this study we explored the optimal timing of radical surgery for LARC, providing a new idea for individualized and precise treatment of LARC.

Keywords

• |locally advanced rectal cancer(larc)|radical surgery|timing for surgery|neoadjuvant chemoradiotherapy