Controversies in Rectal Cancer

Over the past several decades, nearly every aspect of rectal cancer treatment has been shaped by rigorous debates over controversial aspects of patient care and disease management. These debates, geared toward optimizing our patients' survival and quality of life, have led over time to some areas of consensus and created standards-of-care such as the technique of total mesorectal excision and utilization of neoadjuvant radiation in locally advanced rectal cancer. Many hotly debated topics, however, have either failed to produce clear consensus. In other areas, improved knowledge and advances have generated subsequent, more refined, differences in opinion. In particular, the increasing adoption of “total neoadjuvant therapy” and “watch-and-wait” has allowed for even more opportunity for nuance and differences of opinion in the multidisciplinary rectal cancer management.