What are the ESMO guidelines on the surgical treatment of rectal cancer?

Updated: Mar 18, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The 2018 European Society for Medical Oncology (ESMO) guidelines include the following key surgical recommendations [22] :

  • Only patients with cT1N0 should be considered for transanal endoscopic microsurgery (TEM), although TEM for more advanced T-stage may be appropriate for patients at high surgical risk after discussion with the patient.
  • More advanced tumors up to and including cT2c/T3a/b should be treated by radical total mesorectal excision (TME) surgery because of higher risks of recurrence and the higher risk of mesorectal lymph node involvement
  • In rare situations, local excision can be an option in patients with a cT1 tumor or in elderly or fragile patients. TEM is then the procedure of choice.
  • Robotic-assisted rectal cancer surgery provides some technical advantages for surgeons compared with conventional laparoscopy, but is still under evaluation.
  • For cT2 tumors < 4 cm, local excision after preoperative RT/CRT has been considered as alternative management to abdominal surgery


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