Treatment algorithm of metastatic rectal cancer

Around 50% of patients suffering from colorectal cancer will develop metastasis within their lifetime. Some liver and lung metastases are amenable to surgical resection, and these patients can enjoy an improved overall survival (OS), although up to 65% will develop some form of recurrence. In the era of precision surgery, with personalised medicine for each individual, a multi-disciplinary approach is required to ensure we are optimising the patient’s treatment. Whilst we know that surgical resection is often a matter of technical limitations, it is not always the correct choice. With the advances in oncotherapy, surgical resection should be reserved for those in whom it is clear will benefit from this. The surgical approach to the synchronous approach of metastatic rectal cancer has created controversy in whether to tackle the primary first, or deal with the metastasis first, or the benefits of neoadjuvant chemotherapy, with or without radiotherapy. In this review article, we aim to summarise the current practices and treatment options for management of metastatic rectal cancer, as well as patient selection.