The evolving treatment of rectal cancer

Abstract

Rectal cancer treatment has advanced in nearly 300 years from a hopeless, morbid outcome to potentially curative treatments with constant improvement in quality of life. This chapter briefly outlines and reviews the historical evolution of the treatment of adenocarcinoma of the rectum. The earliest procedures were mostly palliative with the first proposed resections for rectal cancer appearing in the eighteenth century. Extirpative procedures utilizing the perineal, vaginal and sacral approaches prevailed until Miles’ abdominoperineal resection in 1908 revolutionized the principles for a correct oncological resection. In time, the focus of interest shifted towards less radical procedures centered on the restoration of intestinal continuity. Later on, sphincter preservation procedures and pouch surgery emerged in an attempt to achieve better functional outcomes. Heald’ s total mesorectal excision proposed in the 1980s represented another milestone in the treatment of rectal cancer by significantly reducing local recurrence rates. Over recent years, combined multimodality therapy and the development of laparoscopic surgery have brought major advancements to the field. In the twenty-first century, the limits of rectal cancer treatment continue to be pushed with surgery still representing the primary form of therapy for optimal oncologic and functional results.