The rectum differs from the rest of large bowel because of its position being the last part of large bowel, which makes it’s resection more difficult. On the other hand, its position gives the chance for radiotherapy, which is beneficial for cancer patients.
Local staging of cancer is extremely important and it is based on magnetic resonance tomography of the anorectal area performed according to a special protocol, in few specialized centers and is diagnosed by specially trained radiologists. MRI staging helps the multidisciplinary team to decide the need for preoperative radiotherapy, chemoradiotherapy and in some cases chemotherapy, delaying the operation for when the most of cancer response is achieved and this could be in 3-4 months time.
In some patients in which a complete response of the tumour is achieved by preoperative treatment we decide to not operate and just proceed with close follow up.
Postoperative radiotherapy does not have as good oncological results, has more and serious complications and it is not preferred.
Rectal excision now days is performed also with extended lymph node dissection and the surgeon should stay within the embryologic planes of fasciae and it is called Total Mesorectal Excision. This gives the best oncologic clearance and avoids damaging the urogenital nerves.