Treatment of rectal cancer - a critical update

The treatment of rectal cancer still remains primarily, surgical in nature. Techniques have evolved from complete extirpation of the rectum and anal c anal which left the patient with a permanent colostomy, to sphincter-saving procedures. Effort is now concentrated on reducing local recurrence by com bining total mesorectal excision with adjuvant radiotherapy and there is go od evidence that both are effective. However; it is likely, that only adjuv ant chemotherapy will improve survival, and numerous studies are currently in progress to determine the best combination of drugs. In addition, attemp ts are being made to improve the functional results of sphincter-saving sur gery: most notably, by the addition of a colonic pouch to the procedure.