NCCN Guidelines® Insights: Rectal Cancer, Version 3.2024
The determination of an optimal treatment plan for an individual patient with rectal cancer is a complex process. In addition to decisions relating to the intent of rectal cancer surgery (ie, curative or palliative), consideration must also be given to the likely functional results of treatment, including the probability of maintaining or restoring normal bowel function/anal continence and preserving genitourinary functions. Particularly for patients with distal rectal cancer, finding a balance between curative-intent therapy while having minimal impact on quality of life can be challenging. Furthermore, the risk of pelvic recurrence is higher in patients with rectal cancer compared with those with colon cancer, and locally recurrent rectal cancer is associated with a poor prognosis. Careful patient selection and the use of sequenced multimodality therapy following a multidisciplinary approach is recommended. These NCCN Guidelines Insights detail recent updates to the NCCN Guidelines for Rectal Cancer, including the addition of endoscopic submucosal dissection as an option for early-stage rectal cancer, updates to the total neoadjuvant therapy approach based on the results of recent clinical trials, and the addition of a "watch-and-wait" nonoperative management approach for clinical complete responders to neoadjuvant therapy.
Authors
- Katrina S. Pedersen (ORCID: https://orcid.org/0000-0003-2793-6901)
- Smitha Krishnamurthi (ORCID: https://orcid.org/0000-0003-2411-3504)
- Christina Wu
- Aparna Parikh
- Benjamin D. Shogan (ORCID: https://orcid.org/0000-0001-9771-4402)
- Hitendra Patel (ORCID: https://orcid.org/0000-0001-8746-2600)
- Christopher G. Willett (ORCID: https://orcid.org/0000-0002-4573-4302)
- David Shibata (ORCID: https://orcid.org/0000-0002-5670-423X)
- Jeffrey A. Meyerhardt (ORCID: https://orcid.org/0000-0002-1120-0898)
- Ignacio Garrido‐Laguna (ORCID: https://orcid.org/0000-0003-2273-9028)
- Al B. Benson (ORCID: https://orcid.org/0000-0001-5485-7227)
- Natalie Kirilcuk
- Sarah E. Hoffe (ORCID: https://orcid.org/0000-0002-6232-8795)
- Mary F. Mulcahy (ORCID: https://orcid.org/0000-0002-6103-0989)
- Leonard B. Saltz (ORCID: https://orcid.org/0000-0001-8353-4670)
- Alan P. Venook (ORCID: https://orcid.org/0000-0001-9749-6548)
- Anna Tavakkoli (ORCID: https://orcid.org/0000-0001-9921-9085)
- Eric David Miller (ORCID: https://orcid.org/0000-0002-4931-3521)
- Jean L. Grem (ORCID: https://orcid.org/0000-0002-1672-9416)
- Dustin A. Deming (ORCID: https://orcid.org/0000-0003-2394-9836)
- George J. Chang (ORCID: https://orcid.org/0000-0002-9758-5361)
- Mohamed A. Adam (ORCID: https://orcid.org/0000-0002-0059-7615)
- Kristen K. Ciombor (ORCID: https://orcid.org/0000-0002-5745-5909)
- Midhun Malla (ORCID: https://orcid.org/0000-0002-9969-588X)
- Kimberly L. Johung (ORCID: https://orcid.org/0009-0001-6931-4599)
- Charles Schneider (ORCID: https://orcid.org/0000-0002-3768-8473)
- Steven Nurkin
- Stacey A. Cohen (ORCID: https://orcid.org/0000-0002-6207-9856)
- Hisham Hussan (ORCID: https://orcid.org/0000-0002-8646-8370)
- Constantinos T. Sofocleous (ORCID: https://orcid.org/0000-0002-3142-1399)
- Wells A. Messersmith (ORCID: https://orcid.org/0000-0003-2349-0885)
- Paul Haste
- Jennifer K. Maratt (ORCID: https://orcid.org/0000-0001-9218-7391)
- Harry S. Cooper (ORCID: https://orcid.org/0000-0001-7574-1928)
- Steven R. Hunt
- Nora Joseph
- Lisa A. Gurski
- Yi-Jen Chen
- J. Randolph Hecht
- John M. Skibber
- Frankie Jones
Institutions
- Fox Chase Cancer Center (US)
- Roswell Park Comprehensive Cancer Center (US)
- Barnes-Jewish Hospital (US)
- City Of Hope National Medical Center (US)
- Cleveland Clinic (US)
- Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa (ZA)
- Memorial Sloan Kettering Cancer Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- University of Tennessee Health Science Center (US)
- Breast Cancer Research Foundation (US)
- University of Utah (US)
- The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (US)
- UC San Diego Health System (US)
- Huntsman Cancer Institute (US)
- Cancer Institute (WIA) (IN)
- Susan Thompson Buffett Foundation (US)
- WinnMed (US)
- Yale Cancer Center (US)
- Moffitt Cancer Center (US)
- Massachusetts General Hospital (US)
- Fred Hutch Cancer Center (US)
- Southwestern Medical Center (US)
- Jewish Hospital (US)
- University of Wisconsin Carbone Cancer Center (US)
- Dana-Farber Cancer Institute (US)
- University Hospitals Seidman Cancer Center (US)
- Duke Medical Center (US)
- University of Colorado Cancer Center (US)
- Smilow Cancer Hospital (US)
- UCSF Helen Diller Family Comprehensive Cancer Center (US)
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
- Moores Cancer Center
- University of Chicago Medicine Comprehensive Cancer Center
- UCLA Jonsson Comprehensive Cancer Center
- Vanderbilt-Ingram Cancer Center
- Stanford Cancer Institute
- Duke Cancer Institute
- Fred and Pamela Buffett Cancer Center
- UC Davis Comprehensive Cancer Center
- Harold C. Simmons Comprehensive Cancer Center
- O'Neal Comprehensive Cancer Center
- National Comprehensive Cancer Network
- Indiana University (US)
- University of Pennsylvania (US)
- University of California, Davis (US)
- The University of Texas Southwestern Medical Center (US)
- University of Colorado Denver (US)
Publication Details
- Journal
- Journal of the National Comprehensive Cancer Network
- Published
- 2024-08-01
- DOI
- https://doi.org/10.6004/jnccn.2024.0041
- Citations
- 168
- Primary Topic
- Colorectal Cancer Surgical Treatments
- Type
- article
- Field-Weighted Citation Impact
- 47.47