New developments in colorectal surgery: German experience

Modern therapy in colon and rectal cancer is a multdisciplinary approach, where high quality surgery is still of primary importance. Several new aspects have evolved during the past years, of which screening colonoscopy, standardization of surgical procedures, quality control, the further development of stage dependend multimodal therapies and fast track rehabilitation have significanly contributed to improving patient outcome. Adjuvant chemotherapy in UICC stage Ⅲ colon cancer patients and neoadjuvant radiochemotherapy in T3/4 and/or lymph node positive rectal cancer patients are well established. The preoperative assessment of the circumferential resection margin in rectal cancer is emerging as an important parameter for the indication to neoadjuvant therapy. In a selected group of patients with early T1 colorectal cancer endoscopic polypectomy might be appropriate while laparoscopic surgery for colon cancer is at the edge of becoming an equivalent option to open surgery. Molecular and genetic factors, such as thymidylate synthase, microsatellite instability or mutations of the K-ras protein, might help to better select patients for adjuvant chemotherapy or antibody based antitumor therapy in the future.