Changing landscape in rectal cancer surgery highlighted

The evolving landscape of rectal cancer surgery was the focus of a presentation by Prof Christina Fleming, Consultant General and Colorectal Surgeon and Adjunct Clinical Associate Professor, University of Limerick Hospital Group, at the Irish Society of Gastroenterology 2026 Summer Meeting.

Prof Fleming has a special interest in surgical innovation, particularly robotic surgery, in relation to locally-advanced colorectal cancer and disorders of the pelvic floor.

Rectal cancer surgery in Ireland is currently centralised in eight centres, with outcomes comparable to those reported internationally, she said.

Prof Fleming was recently awarded a major research grant by the Irish Cancer Society to investigate the survivorship needs of rectal cancer patients, specifically the sexual health of female patients, as part of the RECTIFY (Rectal Cancer Evaluation for Treatment Impact on Quality-of-Life) research study.

She outlined developments in rectal cancer treatment and surgery, alongside the changing younger patient population and the growing recognition of the long-term health consequences of rectal cancer treatment.

Peri-operative surgical morbidity is high in this patient population, with significant bowel, urinary, and sexual dysfunction impacting the majority of patients (70–80 per cent).

In recent years, there has been a shift towards organ preservation and surgery-sparing (‘watch and wait’) approaches where appropriate.

“In 2026, total mesorectal excision is very much reserved for more locally-advanced tumours or tumours that are confined to the rectum and can be resected,” Prof Fleming said.

Given the anatomical constraints of the rectum and its proximity to many vital organs, minimally-invasive and robotic surgical approaches have been shown to have good disease and cosmetic outcomes, while also supporting faster recovery and improving the patient experience, she added.

“With regards to sexual function, we find robotic surgery performs better in that domain… [largely due to] the stability and precision offered by the robotic platform, though it is the most expensive approach.”

Successful organ preservation in rectal cancer is an evolving field and aims to achieve non-inferior oncological outcomes together with improved functionality and survivorship, she told the meeting.

Modern neoadjuvant therapy for rectal cancer, together with increasing the interval to tumour response, means more patients can be managed successfully with organ preservation, both as an opportunistic event and as a planned treatment strategy.

The addition of local excision to oncological therapy can further improve organ preservation rates.

Cancer outcomes in patients afforded organ preservation are now comparable to those of total mesorectal excision, Prof Fleming reported.

 More research is needed to establish consensus on follow-up protocols and to define criteria for oncological and functional success to facilitate patient-centred decision-making.