Guidance on the Surgical Management of Rectal Cancer: An Umbrella Review

Abstract

This umbrella review synthesizes international guidelines on the surgical management of rectal cancer to provide unified recommendations tailored to local healthcare organizations. This review emphasizes the importance of surgical centralization in high-volume centers, which maximizes outcomes, reduces morbidity, and increases survival rates. Minimally invasive approaches, such as laparoscopy and robotic surgery, are highlighted for their perioperative benefits, although careful patient selection and surgical expertise are required. Mechanical bowel preparation combined with oral antibiotics is recommended to effectively reduce complications, including surgical site infections and anastomotic leakage. Enhanced Recovery After Surgery protocols have been shown to significantly improve postoperative recovery and reduce hospital stay duration. Comprehensive perioperative care, including venous thromboembolism prophylaxis and infection control, is essential for optimal patient outcomes. This review underscores the need for structured training, certification, and regular audits for advanced techniques such as robotic surgery and transanal total mesorectal excision. Implementation of a national database is recommended to support ongoing improvements in rectal cancer surgery. This review centralizes evidence-based recommendations to guide surgical decision-making and harmonize the multidisciplinary care for patients with rectal cancer.