Rectal cancer treatment has evolved during the past 40 years with the use of a standardized surgical technique for tumour resection: total mesorectal excision. A dramatic reduction in local recurrence rates and improved survival outcomes have been achieved as consequences of a better understanding of the surgical oncology of rectal cancer, and the advent of adjuvant and neoadjuvant treatments to compliment surgery have paved the way for a multidisciplinary approach to disease management. Further improvements in imaging techniques and the ability to identify prognostic factors such as tumour regression, extramural venous invasion and threatened margins have introduced the concept of decision-making based on preoperative staging information. Modern treatment strategies are underpinned by accurate high-resolution imaging guiding both neoadjuvant therapy and precision surgery, followed by meticulous pathological scrutiny identifying the important prognostic factors for adjuvant chemotherapy. Included in these strategies are organ-sparing approaches and watch-and-wait strategies in selected patients. These pathways rely on the close working of interlinked disciplines within a multidisciplinary team. Such multidisciplinary forums are becoming standard in the treatment of rectal cancer across the UK, Europe and, more recently, the USA. This Review examines the essential components of modern-day management of rectal cancer through a multidisciplinary team approach, providing information that is essential for any practising colorectal surgeon to guide the best patient care.

在过去的40年中，通过使用标准化的手术技术切除肿瘤：全直肠系膜切除术，直肠癌治疗得到了发展。由于对直肠癌外科肿瘤学有了更好的了解，局部复发率显着降低，生存结果得到改善，辅助治疗和新辅助治疗的出现为辅助性手术的出现铺平了疾病管理的多学科方法的道路。 。成像技术的进一步改进以及识别诸如肿瘤消退，壁外静脉浸润和边缘受威胁等预后因素的能力已经引入了基于术前分期信息的决策概念。现代治疗策略的基础是精确的高分辨率影像，可指导新辅助治疗和精密外科手术，然后进行细致的病理学检查，确定辅助化疗的重要预后因素。这些策略包括选定患者的器官保留方法和观察和等待策略。这些途径依赖于多学科团队中相互联系的学科的紧密合作。这样的多学科论坛正在英国，欧洲以及最近在美国的直肠癌治疗中成为标准。这篇综述通过多学科团队方法研究了现代直肠癌治疗的基本组成部分，提供了任何执业结直肠外科医师指导最佳患者护理必不可少的信息。