The treatment of rectal cancer, one of the most important surgical challenges, has undergone major changes. Initially, the possibility of cure involved amputation of the sphincters, which implied a definitive artificial anus (colostomy). Fortunately, in the 80’s of the last century, more than half of the patients could be treated preserving defecation through the anus.
Subsequently, the improvement of the surgical technique with the complete removal of the rectal sheath (mesorectum) and the multidisciplinary treatment of the oncologist or radiotherapist among other specialists, has achieved that more than 85% of patients maintain their anal sphincters and, furthermore, that survival reaches 80%.
But it has been in this millennium that laparoscopic surgery together with better postoperative care has achieved a faster recovery with fewer complications. In addition, certain lesions can be removed through the anus with precision by endoscopic microsurgery and the combination of laparoscopy with these techniques also called TEM, TEO or TAMIS. These techniques are making it possible to achieve “transanal excision of the mesorectum”, thus achieving higher surgical quality with less aggression, without requiring the abdomen to be opened.
And this is not all, the improvement of neoadjuvant treatments (chemo-radiotherapy) prior to surgery and the fact of increasing the waiting time until the intervention after their use so that they act more effectively, is causing the tumor to have disappeared or to have been very notably reduced when we operate on the patient, which translates into a much better result.
In the near future, it is possible that by personalizing the treatment, surgery could even be avoided in some cases, with all that this entails. The reality is that the results have improved notably both in the cure of this terrible disease and in the quality of life of our patients.