What are the current guidelines for the management of rectal cancer in terms of surgical options and adjuvant therapy?

For surgical options in rectal cancer, offer surgery to people with resectable tumours, including options such as transanal excision, endoscopic submucosal dissection, and total mesorectal excision (TME), with the choice depending on tumour characteristics and patient factors ¹.

Minimally invasive approaches like laparoscopic surgery are recommended, with consideration of open surgery if clinically indicated, and robotic surgery only within established programmes with audited outcomes ¹.

Transanal TME surgery should be considered only in research settings in line with NICE guidance ¹.

For locally advanced or recurrent rectal cancer, referral to specialist centres for exenterative surgery is advised ¹.

Regarding adjuvant therapy, for stage III rectal cancer, offer 3 months of capecitabine with oxaliplatin (CAPOX) or oxaliplatin with 5-fluorouracil and folinic acid (FOLFOX), or 6 months of single-agent fluoropyrimidine, based on patient factors and preferences ¹.

Patients with early rectal cancer (cT1-T2, cN0, M0) should be offered one of the treatments after shared decision-making, with preoperative radiotherapy or chemoradiotherapy indicated for more advanced stages (cT1-T2, cN1-N2, M0, or cT3-T4, any cN, M0) ¹.