Treatment of Localised Rectal Cancer in the Lower or Middle Third of the Rectum When Surgery Is Intended

Management of localised rectal cancer located in the lower or middle third of the rectum when surgery is intended. The standard surgical approach for locally advanced tumours in the middle or lower third of the rectum remains total proctectomy with TME, which has demonstrated a substantial benefit in decreasing local recurrence rates.

Neoadjuvant therapy prior to surgery is recommended, with the specific strategy guided by tumour stage and individual risk profile. The approach differs between standard-risk and high-risk tumour presentations — the complete structured regimen details which strategy applies in each setting.

Primary tumour response (downsizing) assessed by MRI at restaging after completion of neoadjuvant therapy. The timing of restaging depends on which neoadjuvant strategy was used.