Key Concepts

• Standardized surgery using the total mesorectal excision concept remains paramount for achieving local control for rectal cancer.
• Addition of neoadjuvant therapy (short-course radiation, long-course chemoradiation) along with standardized surgery improves local control.
• Neoadjuvant short-course radiation therapy and long-course chemoradiation therapy have not improved DFS or OS for patients with LARC.
• Increased time interval between the completion of radiation therapy and surgery directly impacts the pathologic response of the primary tumor.
• The administration of systemic multidrug chemotherapy in the neoadjuvant setting as either induction or consolidation relative to radiation therapy has led to improved primary tumor response, improved tolerance, and improved delivery.