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The role of multimodality treatment in M0 rectal cancer: evidence and research.

In the last two decades we have seen major advances in the strategy of the treatment of rectal cancer. Important studies were published to confirm the role of imaging MRI in the treatment plan and in detecting the prognostic factors, the improved outcome of the new surgical technique based on total mesorectal excision and the combined treatments. Many studies demonstrated that MRI is equivalent to histology in measurement of extramural depth, is also highly accurate in staging advanced rectal cancer, in the assessment of mesorectal fascia infiltration and to distinguish cT3 from cT4, in the measuring the distance from the anorectal ring. With the introduction of total mesorectal excision the local recurrence rate is dramatically reduced, especially in selected centres. Preoperative radiotherapy +/- in combination with chemotherapy still reduces this rates respect to only surgery or postoperative treatment. In this time of changing therapeutic approaches, a common standard for large heterogeneous patient groups will likely be substituted by more individualised therapies. It will depend from new evidence of more tailored diagnosis, surgery, radiotherapy and chemotherapy.