Rectal Cancer: Open Questions in 2022 Current Standards of Clinical Practice and Ongoing Trials

Background: Rectal cancer remains a complex disease and a relevant global health issue, increasingly affecting also younger patients. This update review summarizes the current standard of care and discusses the individualized treatment approaches taking into consideration individual tumor characteristics and patients preferences. Summary: Remaining “gray zones” of rectal cancer therapy warranting further prospective studies are identified including surgical approaches for rectal cancer, e.g., minimally invasive surgical techniques and lateral lymph node dissection for low rectal cancers. The emerging concept of a watch-and-wait strategy upon clinical complete response after chemoradiotherapy is discussed, also considering the still limited evidence and the clinical challenges arising from individualized patient management. Key Messages: Finally, currently conducted clinical trials of the German Rectal Cancer Study Group are described, aiming to further individualize multimodal treatment according to risk profiles and strict MRI criteria.