Introduction: The management of rectal cancer in Ireland has evolved significantly in recent years, driven by advancements in imaging, therapeutic modalities including surgical techniques and a growing focus on personalised care. While surgery remains the primary treatment for rectal cancer confined to the bowel wall, for the past two decades, neoadjuvant long-course chemoradiotherapy (CRT) has become the cornerstone of treatment for locally advanced rectal cancer (LARC), aiming to downstage tumours to improve resectability and reduce recurrence rates.1-5
The potential for organ-preserving approaches in complete or near complete clinical responders (cCR and CR respectively) resulting from this adjuvant treatment has been increasingly utilised, sparing selected patients the morbidity of radical surgery, meaning that there has been increased consideration of “neoadjuvant therapy” as “primary therapy”. Most recently the concept and practice of Total Neoadjuvant Therapy (TNT), has opened new opportunities to integrate systemic chemotherapy earlier in the treatment pathway. This approach has demonstrated improved outcomes for patients with high-risk disease, including better systemic control and increased rates of pathological complete response (ypCR).6 There is increasing interest in such treatment with the specific aim of achieving cCR and avoiding surgery altogether.7, 8 Simultaneously, technological advancements in surgical approaches, particularly the incorporation of robotic-assisted and transanal surgical techniques have expanded the surgical armamentarium for rectal cancer resection meaning both extended and localised procedures are enabled as either definitive or significant component of cancer care.9, 10
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