Overview of Rectal Cancer and Its Surgical Management

Overview of Rectal Cancer and Its Surgical Management

Rectal cancer remains a significant public health concern, being the third most common cancer globally and a leading cause of cancer-related deaths. In the United States, approximately 46,000 cases of rectal adenocarcinoma are diagnosed annually, with its presentation often characterized by symptoms such as rectal bleeding, the sensation of a rectal mass, iron deficiency anemia, and abdominal pain (1). The management of this malignancy has evolved considerably, with surgery being the cornerstone of treatment. Surgical options primarily include rectal anterior resection (RAR) with total mesorectal excision (TME) or partial mesorectal excision (PME), depending on the tumor’s location and the patient’s overall health status.

The technical complexity of these procedures necessitates that they be performed in high-volume centers to optimize oncological outcomes while minimizing morbidity (2). Advances in surgical techniques, particularly the advent of minimally invasive surgery (MIS), have been pivotal in enhancing patient recovery times and reducing postoperative complications. Laparoscopic and robotic-assisted approaches have emerged as effective alternatives to traditional open surgery, offering benefits such as reduced postoperative pain, shorter hospital stays, and quicker return to normal activities (3).

Common Complications Associated with Rectal Surgery

Despite the advancements in surgical techniques, complications following rectal surgery remain a concern. Anastomotic leakage (AL), a significant postoperative complication, occurs in 2% to 19% of patients and is associated with increased morbidity and mortality (4). The clinical signs of AL typically include fever, tachycardia, abdominal pain, purulent discharge through drainage, and dynamic bowel obstruction (5). Furthermore, AL can lead to local disease recurrence, necessitating urgent surgical interventions (6).

Other complications associated with rectal surgery include surgical site infections (SSI), which can significantly prolong hospitalization and impact recovery (7). The presence of a stoma, particularly in patients undergoing Hartmann’s procedure, can also lead to complications such as stoma-related dermatitis, prolapse, and psychological distress due to the alteration in body image (8). Understanding these complications and their management is crucial for improving patient outcomes.

Role of Stoma Creation in Managing Rectal Cancer

Stoma creation is often employed in the management of rectal cancer, especially when the primary resection cannot be performed safely or when there is a high risk of complications such as AL. A temporary stoma can protect an anastomosis, allowing for healing and recovery before reversal (9). The decision to create a stoma, such as an ileostomy or colostomy, is generally influenced by factors such as the extent of the disease, the patient’s nutritional status, and the anticipated technical challenges of the primary surgery.

Stoma creation can provide significant benefits, including the prevention of fecal incontinence and the reduction of postoperative complications associated with anastomotic failure (10). However, it is essential to consider the psychological and social implications of living with a stoma. Patients often report feelings of embarrassment and isolation, which can adversely affect their quality of life (11). Therefore, a multidisciplinary approach involving surgical, psychological, and nutritional support is critical in managing patients with stomas.

Importance of Multidisciplinary Care in Rectal Cancer Treatment

The management of rectal cancer necessitates a comprehensive approach that includes a multidisciplinary team (MDT). This team typically comprises surgical oncologists, medical oncologists, radiation oncologists, dietitians, and mental health professionals (12). The collaborative effort ensures that all aspects of patient care are addressed, from preoperative assessment and planning through postoperative recovery and rehabilitation.

Multidisciplinary care is particularly important in formulating treatment plans that are tailored to individual patient needs. For instance, patients with significant comorbidities may require more intensive preoperative optimization, while those with advanced disease might benefit from neoadjuvant therapies to shrink tumors before surgical intervention (13). Additionally, ongoing support from mental health professionals can help patients cope with the emotional challenges associated with cancer treatment and recovery.

Advances in Minimally Invasive Techniques for Rectal Surgery

Minimally invasive surgical techniques have revolutionized the approach to rectal cancer surgery. Laparoscopic and robotic-assisted techniques allow for precise dissection and reconstruction with minimal trauma to surrounding tissues, resulting in several advantages over traditional open surgery, including reduced postoperative pain, fewer complications, and shorter recovery times (14).

A systematic review indicated that laparoscopic techniques are associated with less blood loss, shorter hospital stays, and lower rates of complications compared to open approaches (15). Robotic surgery, while still emerging, provides enhanced visualization and instrument maneuverability, which can facilitate complex resections and anastomoses (16). These advancements underline the importance of ongoing training and investment in surgical technology to improve patient outcomes in rectal cancer management.

References

1. An Alteration to Standardized Treatments: Defunctioning Colostomy in Ultra-Low Stage IIIC Rectal Adenocarcinoma. https://doi.org/10.17161/kjm.vol18.23567

2. Emergency laparoscopic Hartmann procedure no longer a subspecialist operation: a retrospective cohort study at an Australian non-subspecialized center. https://pubmed.ncbi.nlm.nih.gov/12179668/

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4. Direction of perforation predicts the failure of non-operative management in patients with acute diverticulitis. https://doi.org/10.1007/s00423-025-03733-5

5. Evidence-based, cost-effective management of acute diverticulitis. An algorithm of the Journal of Trauma and Acute Care Surgery emergency general surgery algorithms work group. https://pubmed.ncbi.nlm.nih.gov/12188818/

6. The Social Challenges of Stomas Faced by Families of Children With Anorectal Malformations in Uganda. https://pubmed.ncbi.nlm.nih.gov/12220878/

7. Reversal of Hartmann’s procedure: The impact of timing – a single-tertiary-center experience. https://doi.org/10.1016/j.sipas.2025.100292

8. An update on “The use of negative pressure wound therapy following stoma reversal: a systematic review and meta-analysis of randomized controlled trials” by Drumm et al. https://doi.org/10.1007/s00384-025-04947-1

9. Adult Presentation of Anorectal Malformation: A 19-Year-Old Woman with a Delayed Diagnosis of Recto-Vestibular Fistula. https://pubmed.ncbi.nlm.nih.gov/12236110/

10. Robotic Surgical Management of Complicated Diverticulitis. https://doi.org/10.1007/s40719-025-00289-z

11. Associations between non-traditional lipid parameters and normoglycemic reversion in Chinese adults with prediabetes: a retrospective analysis. https://doi.org/10.3389/fendo.2025.1502861

12. The impact of timing on intraoperative and postoperative outcomes following Hartmann’s reversal. https://doi.org/10.1016/j.sipas.2025.100292

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14. Current management of diverticulitis: a review. https://doi.org/10.1007/s40719-025-00289-z

15. Adult Presentation of Anorectal Malformation: A 19-Year-Old Woman with a Delayed Diagnosis of Recto-Vestibular Fistula. https://pubmed.ncbi.nlm.nih.gov/12236110/

FAQ

What is rectal cancer?
Rectal cancer is a type of cancer that occurs in the rectum, the final section of the large intestine. It can present with symptoms such as rectal bleeding, changes in bowel habits, and abdominal pain.

What are the common surgical techniques for rectal cancer?
Common surgical techniques include rectal anterior resection (RAR) and total mesorectal excision (TME). These techniques aim to remove the cancerous tissue while preserving as much of the surrounding healthy tissue as possible.

What complications can arise from rectal surgery?
Complications can include anastomotic leakage, surgical site infections, and stoma-related issues. These complications can lead to longer recovery times and may require additional surgical interventions.

How does stoma creation impact recovery from rectal cancer surgery?
Stoma creation can protect the anastomosis and allow for healing. However, it can also lead to psychological and social challenges for patients, which require comprehensive management.

Why is multidisciplinary care important in treating rectal cancer?
Multidisciplinary care ensures that all aspects of patient treatment are addressed, including surgical, medical, psychological, and nutritional support, which is essential for optimizing patient outcomes.

What advances have been made in minimally invasive surgical techniques for rectal cancer?
Recent advances include laparoscopic and robotic-assisted surgeries, which offer benefits such as reduced postoperative pain, shorter hospital stays, and improved recovery times compared to traditional open surgeries.