Ergin ERGİNÖZ
Cerrahpaşa Medical Journal - 2026;50(1):1-3
The management of locally advanced rectal cancer (LARC) has evolved substantially over the past decade, shifting from a standardized surgical approach to an individualized, response-guided treatment paradigm. Historically, long-course neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) achieved excellent local control but caused significant functional morbidity. Permanent stomas, fecal incontinence, urinary and sexual dysfunction were frequent, profoundly affecting quality of life. The advent of total neoadjuvant therapy (TNT), where systemic chemotherapy is administered before surgery as induction or consolidation, enhanced tumor regression and treatment compliance, doubling the rates of pathologic and clinical complete responses (pCR, cCR). This progress enabled the watch-and-wait (WW) strategy, in which surgery is deferred for patients with verified cCR who undergo surveillance.
