The treatment of locally advanced rectal cancer (LARC) has evolved significantly over
the past century, driven by a deeper understanding of tumor biology, technological
advancements, and multidisciplinary approaches. This article reviews the historical
progression of LARC management, emphasizing the latest breakthroughs that are reshaping
treatment paradigms. Key developments include the watch and wait strategy for patients
achieving a complete clinical response after neoadjuvant therapy, the emergence of
total neoadjuvant therapy as a standard approach, and the adoption of minimally invasive
surgical techniques, such as transanal endoscopic microsurgery. Watch and wait may
reduce treatment-related morbidity and help preserve anorectal function, but it requires
rigorous patient selection and close long-term surveillance to ensure oncologic safety.
Additionally, the role of targeted therapies and immunotherapy is gaining prominence,
offering new opportunities for personalized treatment. These innovations aim to improve
oncological outcomes while minimizing morbidity and preserving organ function, ultimately
enhancing patients’ quality of life. Despite these advancements, challenges remain
in optimizing patient selection, refining treatment strategies, and ensuring long-term
safety and efficacy. A multidisciplinary approach involving surgeons, oncologists,
and radiation specialists is crucial to tailoring therapies to individual patient
profiles. As research continues, integrating novel therapeutic strategies will be
key to further improving survival rates and reducing treatment-related morbidity in
LARC patients.
