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Invited Commentary
Surgery
July 8, 2020

Clinical Advantage of Image-Guided Navigation for Locally Advanced Primary and Recurrent Rectal Cancer

Author Affiliations
  • 1Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
JAMA Netw Open. 2020;3(7):e208810. doi:10.1001/jamanetworkopen.2020.8810

Rectal cancer care has undergone a major paradigm shift during the past 40 years. Beginning with the teachings of Richard J. (Bill) Heald and subsequently including the works of many other individuals, total mesorectal excision has become the globally accepted standard for the optimal radical resection of rectal cancer.1,2 Variability in rectal cancer care in the United States and worldwide led to a collaboration among 8 professional societies to create the National Accreditation Program for Rectal Cancer of the American College of Surgeons Commission on Cancer.3 One of the fundamental principles underlying the National Accreditation Program for Rectal Cancer is performing preoperative imaging to enable a multidisciplinary team to reach consensus on the use of neoadjuvant chemoradiotherapy compared with a surgeon ultimately obtaining a tumor-free circumferential resection margin (CRM).4 Tumors that threaten the intended CRM by encroaching within 1 mm (or 2 mm) of the edge of the mesorectal envelope are generally deemed appropriate candidates for preoperative neoadjuvant chemoradiotherapy.5

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