Rectal Cancer – The Role of the Surgeon – Speech 2025

The role of the surgeon in treatment and survival in rectal cancer. Speech at a gastroenterology conference 12/2025.

1. Key member of the multidisciplinary team together with an oncologist and radiation therapist.
2. Primary role in staging and treatment planning (important to assess before starting any treatment).
3. The operation is planned based on the initial location and size of the tumor.
4. Accurate measurement of the distance in the lower rectum is critical to avoid a colostomy (even 1-2cm is enough)
5. Involved in deciding whether preoperative (neoadjuvant) chemoradiotherapy is needed to shrink the tumor and reduce the risk of local recurrence
6. The surgeon leads the surgical planning and decides the type of operation
7. Management of complications (ileus, perforation, bleeding, stricture, fistulas, postactinal colitis)

The specialized surgeons in rectal cancer

• Significantly reduce local recurrence rates by up to 30%
• Reduce the need for a permanent colostomy by up to 25%
• Achieve better future sphincter function through total mesorectal resection (TME)
• Experience is associated with reduced involuntary damage to the pelvic nerves (sexual and urological disorders) and anal sphincter complex
• 35% Reduction in 30-day mortality
• Achieve a 40% relative risk reduction especially in rectal resections, regardless of hospital volume, highlighting the specific technical skills of the surgeon.

Conclusions

1. Multidisciplinary team mandatory for all oncology patients
2. Colorectal surgeon core team member in rectal cancer
3. The initial staging by the surgeon for planning the operation before any treatment is critical
4. The operation is planned based on the original location of the tumor and not after it will shrink (unless there is a risk of a permanent stoma and the patient does not want it)
5. Surgeon experience and expertise increases survival by 15-25%, reduces complications and especially anastomotic leaks by 40-50% and reduces permanent colostomies by 25%
6. With the transsphincteric or intersphincteric (Intersphincteric) we can maintain the sphincter even in tumors touching the dentate line as long as we have a 1cm healthy margin.
7. Pull-through coloanal anastomosis can reduce the need for temporary stoma, correct complications of previous operations or treatments, and provide a second chance to avoid a permanent stoma (revision surgery).