Rectal cancer is best managed by a multidisciplinary team

During the last 40 years, numerous advances have been made in the evaluation and management of rectal cancer. The initial recognition of the importance of total mesorectal excision and of obtaining tumor free circumferential resection margins was further advanced by the advent of an advocacy for high resolution rectal cancer protocol pelvic MRI reported with synoptic methodology. The role of the pathologist in being able to recognize and differentiate between complete or near complete and incomplete mesorectal specimens as well as to describe the number of millimeters of the circumferential and distal resection margins as well as to identify and evaluate at least 12 lymph glands is of paramount importance. These individual roles of surgery, imaging, and specimen evaluation converge within the multidisciplinary team. The review which I coauthored with Deborah S. Keller, Mariana Berho, Rodrigo O. Perez, and Manish Chand in Nature Reviews Gastroenterology & Hepatology describes our evolution and current status. Achieving these goals is the cornerstone of the American College of Surgeons Commission on Cancer National Accreditation Program for Rectal Cancer.