Organ Preservation in Rectal Cancer

Globally, colorectal cancer is the fourth most common cancer and the third most common cause of cancer related deaths. Its treatment faces multiple challenges, including, numerous treatment options, the risk of major resectional surgery with subsequent risk of colostomy and balancing therapies with quality of life. For rectal cancer the choice of treatment is dependent on various factors including the patient's age, health status, tumor location and size, stage of disease, as well as local guidelines and practices. Common treatment and therapeutic approaches for patients with colorectal cancer involve multimodal therapies such as chemotherapy and radiotherapy in an attempt to reduce tumor size and potentially require less invasive surgical methods. In select cases, chemo-radiotherapy can induce a complete clinical response and eliminate the need for surgery. Response to neoadjuvant chemoradiotherapy can be both variable and difficult to predict. There is currently a lack of both predictive and specific therapeutic biomarkers to guide that treatment strategy. The concept of a personalized medicine approach based on tumor biology would be the overall goal.

Furthermore, there is growing evidence that advanced techniques in early stage rectal cancer, including transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), which exercise very precise and specific excision of tumors, are successful in preserving the function of the anus and eliminating the requirement for a permanent colostomy. As a result, there is a strong interest in the development of organ-preserving strategies to significantly increase the patient's quality of life by increased retention of organ function.

The goal of this Research Topic is to discuss the potential strategies for organ preservation in patients with rectal cancer. We would encourage novel articles both in vitro and in vivo that investigate possible neoadjuvant methods for inducing clinical responses in rectal cancer (total neoadjuvant therapy). Additionally, articles pertaining to contact radiotherapy, minimally invasive surgery and long term follow up of patients who have undergone organ preservation are also of great interest. We would also encourage research assessing quality of life and patient reported outcomes within this topic where evidence is lacking. We welcome Original Research, Review, Systematic Reviews and Mini-reviews.

Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.