To describe the future of rectal management, Dr. Delaney initially highlights the major achievements in rectal cancer surgery over the last 20 years: imaging, minimally invasive approaches, TaTME, and chemotherapy. Every improvement old and new should focus on improving overall survival, operative mortality, morbidity, reoperation and readmission and return to normal activity, resulting in a sustainable health system while improving patient care.
Among the different changes that rectal cancer management will face over the next 20 years, Dr. Delaney emphasized:
– Microbiome: it may be one of the key pillars for the future, although more research is still necessary to understand its role in surgery.
– Personalized treatment: based on biobank analysis, decision-making could be guided by biopsy and genetic analysis. This will help to predict the response to chemoradiation, surgery, peri-operative medication, etc.
– Watch & wait, where studying the response to chemotherapy may lead to organ-preserving surgery.
– Imaging: it may determine more accurately the response to treatment and support decision-making more solidly.
– Algorithms for surgical approaches, where the gold standard from among open, laparoscopic, robotic, or transanal total mesorectal excision is yet to be established.
– Technique and reduction of complications: technique standardization, simulation-based teaching would lead to a decrease in complications. Similarly, complications treatment should be standardized to achieve better outcomes.
– Perioperative care, including bowel preparation, oral antibiotics, analgesics, etc.
– Quality and centers of excellence, to centralize rectal cancer cases in reference centers to improve the overall outcomes and national accreditation programs for rectal cancer.
– Value, involving the patient’s perspective, quality, and financial considerations.