With the development of surgical techniques, adjuvant therapy and neoadjuvant therapy, the survival time of rectal cancer patients after surgery has been significantly improved, but organ dysfunction is still an important problem affecting the quality of life of patients after surgery. With the continuous deepening of clinical research and practice and the updating of relevant theories, more detailed and reliable evidence-based medical evidence has been accumulated in the field of pelvic organ function protection in rectal cancer surgery, and has been continuously verified in the clinical real world at home and abroad. In order to further improve the awareness of domestic physicians on the protection of organ function during the treatment of rectal cancer, standardize the evaluation methods and surgical methods, reduce the incidence of organ dysfunction, and thus improve the quality of life of patients, Society of Colon & Rectal Surgeons of Chinese College of Surgeons of Chinese Medical Doctor Association, Section of Colorectal Surgery of Branch of Surgery of Chinese Medical Association, National Health Commission Capacity Building and Continuing Education Center Colorectal Surgery Committee, and Colorectal and Anal Function Surgeons Committee of China Sexology Association organized the discussion among relevant experts. On the basis of the 2021 edition of the Chinese Expert Consensus on the Protection of Pelvic Organ Function in Rectal Cancer Surgery, the recent evidence-based medical evidence was analyzed and summarized, and the definition, risk factors, evaluation methods, prevention and other issues of organ dysfunction after rectal cancer surgery were analyzed with reference to relevant domestic and foreign studies and combined with clinical practice. Proposed the diagnosis, evaluation and treatment of pelvic organ dysfunction in rectal cancer surgery, and finally formed the "Chinese expert Consensus on the protection of pelvic organ function in rectal cancer surgery (version 2025)".
Humans ; Rectal Neoplasms/surgery* ; Consensus ; Pelvis/physiopathology* ; Quality of Life ; Postoperative Complications/prevention & control*

Tianhe procedure^® is a functional sphincter-preserving surgical approach developed for rectal cancer patients following radiotherapy. This technique involves extended proximal resection of the colon beyond the pelvic cavity, followed by anastomosis of the non-irradiated proximal colon to the distal rectum or anal canal. This strategy aims to reduce the incidence of anastomotic complications and postoperative bowel dysfunction. However, there is currently a lack of standardized practice guideline for implementing Tianhe procedure^® in China. Therefore, the Chinese Radiation Intestinal Injury Research Group, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, the Anorectal Branch of Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, and the Colorectal Cancer Committee of China Anti-cancer Association, and the Gastrointestinal Surgical Branch of Guangdong Medical Doctor Association, have jointly convened a panel of national experts to discuss and establish this standardized surgical procedure. This standard, based on the latest evidence from literature, research advancements, and expert experience, focuses on key aspects of the Tianhe procedure^®, including its precise definition, indications, critical procedural steps, postoperative complications, and functional rehabilitation strategies. It aims to promote standardized implementation and broader clinical adoption of this innovative surgical technique.
Humans ; Rectal Neoplasms/radiotherapy* ; Anal Canal/surgery* ; Anastomosis, Surgical/methods* ; Organ Sparing Treatments/methods* ; Rectum/surgery* ; Postoperative Complications/prevention & control* ; Digestive System Surgical Procedures/methods*

Low anterior resection syndrome (LARS) is a common bowel dysfunction syndrome following sphincter-preserving surgery for rectal cancer, characterized by stool storage dysfunction and evacuatory dysfunction. It has become a critical factor adversely affecting patients' quality of life and long-term clinical outcomes. Currently, the pathogenic mechanisms of LARS remain incompletely elucidated, and high-quality evidence to guide clinical practice is still lacking. However, emerging evidence suggests that strategic optimization across the clinical management pathway-including precision oncology planning, surgical technique selection, multidimensional symptom profiling, proactive prevention protocols, and comprehensive symptom management-may effectively reduce LARS severity and improve survivorship outcomes. Given the absence of consensus guidelines for LARS management among clinicians across China, the Chinese Society of Coloproctology (Chinese Medical Doctor Association) organized domestic experts in relevant fields. Through systematic review of global research findings, integration of international expertise and guidelines, and adaptation to domestic clinical realities, we developed the "Chinese Expert Consensus on the Diagnosis and Treatment of Low Anterior Resection Syndrome (2025 Edition)". This consensus elaborates on key aspects including the definition, clinical manifestations, risk factors, pathophysiological mechanisms, symptom assessment, treatment modalities, and prevention strategies for LARS, aiming to standardize the diagnosis and management of LARS in China.
Humans ; Rectal Neoplasms/surgery* ; Consensus ; Postoperative Complications/therapy* ; Quality of Life ; Syndrome ; China ; Low Anterior Resection Syndrome

The modified Bacon procedure is a staged, sphincter-preserving surgical technique for low rectal tumors, which involves transanal or transabdominal division of the tumor, extraction of the specimen via the anus or abdomen, exteriorization and fixation of the proximal colon through the anus, followed by a second-stage resection of the exteriorized colon to restore intestinal continuity. This approach offers advantages such as a reduced risk of anastomotic leakage and operational safety. However, several clinical aspects lack consensus, including indications for the procedure, the optimal length of the exteriorized colon, methods of anal fixation, and the timing of the second-stage resection. To address these issues, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, the Colorectal Cancer Committee of China Anti-Cancer Association, and the NOSES Committee of China Anti-Cancer Association jointly initiated a collaborative effort to convene experts in the field. Through discussions, 10 key clinical questions were identified, and based on a systematic review of relevant domestic and international clinical studies combined with expert opinions, 13 recommendations were formulated. These recommendations cover indications, contraindications, technical details, surgical complications, functional outcomes related to anal function, and oncological efficacy of the modified Bacon procedure. This consensus aims to provide guidance for the clinical practice of the modified Bacon procedure in China, thereby promoting its standardized and evidence-based implementation.
Humans ; Rectal Neoplasms/surgery* ; Consensus ; Anal Canal/surgery*

Currently, the standard of clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) for local advanced rectal cancer generally lacks pathological examination, the cCR judged by the current standard is still far from the real pathological complete response. After nCRT, due to the presence of tissue edema and fibrosis, MRI is highly uncertain in determining the staging of local lesions. The precision of colonoscopy biopsy is generally low because residual cancer foci exist primarily in the muscular layer, which limits the determination of cCR by colonoscopy biopsy. Local excision through the anus can resect the whole intestinal wall tissue, which is relatively accurate and close to the real state of remission of the lesion, but there are many problems, such as affecting anal function, high rate of complications, and increased difficulty of following radical surgery. Based on the present diagnosis of cCR, the authors put forward the concept of modified cCR (m-cCR) which combined with the pathological standard of transanal multipoint full-layer puncture biopsy. It is possible to improve the accuracy of cCR, and improve the safety of cCR patients who receive wait-and-watch therapy without increasing complications or affecting anal function. The exact conclusion needs to be confirmed by further studies.
Humans ; Neoadjuvant Therapy ; Treatment Outcome ; Neoplasm Recurrence, Local/diagnosis* ; Watchful Waiting ; Rectal Neoplasms/surgery* ; Chemoradiotherapy

Although transanal endoscopic surgery has been developed for more than 40 years, it remains relatively unknown to most domestic colleagues. In 2019, the Chinese Society of Transanal Total Mesorectal Excision (CSTa) and the Chinese Society of Colon and Rectal Surgeons (CSCRS) organized domestic experts to write and publish the "Chinese Expert Consensus on Transanal Endoscopic Surgery (2019 Edition)", which elaborated on the definition, surgical methods, indications, contraindications, basic principles, key issues and complications of transanal endoscopic surgery, and provided a certain theoretical foundation for the development of transanal endoscopic surgery in China. In the past four years, the scope of application of transanal endoscopic techniques has been expanded, and many prospective and retrospective clinical research have provided more evidence-based medical evidence. Therefore, the Chinese Society of Transanal Total Mesorectal Excision (CSTa) once again organized domestic experts to write the "Expert Consensus and Operation Guidelines for Transanal Endoscopic Surgery in China (2023 Edition)", updating the expert consensus opinions on the definition, indications, complications and learning curve of transanal endoscopic surgery and adding operation guidelines. The aim is to promote the standardized practices in transanal endoscopic surgery and facilitate a shorter learning curve for surgeons.
Humans ; Rectum/surgery* ; Rectal Neoplasms/surgery* ; Consensus ; Prospective Studies ; Retrospective Studies ; Transanal Endoscopic Surgery/methods*

Conformal sphincter-preservation operation (CSPO) is considered the effective surgical technique for preserving the sphincter in cases of low rectal cancer. Accurate preoperative diagnosis and staging, reasonable selection of surgical approaches and technique, standardized perioperative management, and postoperative rehabilitation are the keys to ensuring the oncological clearance and functional preservation of CSPO. However, there is currently a lack of standardized surgical procedure for implementing CSPO in China. Therefore, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association,along with the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Anorectal Branch of Chinese Medical Doctor Association, gathered experts in colorectal surgery to discuss and establish this standardized surgical procedure of CSPO. This standard, based on the latest evidence from literature, expert experiences, and China national condition, focuses on the definition, classification, pelvic anatomy, surgical techniques, postoperative complications, and perioperative care of CSPO. It aims to guide the standardized clinical practice of CSPO in China.
Humans ; Anal Canal/surgery* ; Rectal Neoplasms/surgery* ; Digestive System Surgical Procedures/methods* ; Pelvis ; Postoperative Complications

Pelvic exenteration is often required for primary rectal cancer beyond total mesorectal excision (PRC-bTME) and locally recurrent rectal cancer (LRRC). Some patients with radical resection can achieve long-term survival, but they need to face risks, such as huge surgical trauma, serious perioperative complications, permanent loss of organ function and decline in quality of life. Preoperative evaluation of PRC-bTME and LRRC should emphasize multidisciplinary collaboration, and develop individualized diagnosis and treatment strategies. The principles of function preservation and risk-benefit balance in surgery oncology should be followed, and R0 resection should be emphasized. Perioperative complications, surgical trauma and organ function loss should be minimized to achieve the best quality control and balance point. This consensus was formulated by the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Gastrointestinal Surgery Committee of China International Exchange and Promotive Association for Medical and Health Care. The draft was formed based on the summary of domestic and foreign research progress and expert experience. After discussion, review and modification by experts, an anonymous voting was conducted for each major opinion, and in-depth verification was carried out according to the principles of evidence-based medicine. Finally, the Chinese expert consensus on the pelvic exenteration with primary rectal cancer beyond total mesorectal excision planes and locally recurrent rectal cancer (2023 edition) was formed. This consensus mainly summarizes the indications and contraindications of PE for PRC-bTME and LRRC, preoperative diagnosis and evaluation, perioperative treatment, as well as the resection scope, surgical methods, reconstruction of related organs, safety and complications of PE, postoperative follow-up and other issues, in order to provide guidance for PE in patients with PRC-bTME and LRRC.
Humans ; Consensus ; Neoplasm Recurrence, Local/surgery* ; Pelvic Exenteration ; Quality of Life ; Rectal Neoplasms/surgery* ; Treatment Outcome ; China

After the implementation of neoadjuvant chemoradiotherapy and total mesorectal excision, lateral local recurrence becomes the major type of local recurrence after surgery in rectal cancer. Most lateral recurrence develops from enlarged lateral lymph nodes on an initial imaging study. Evidence is accumulating to support the combined use of neoadjuvant chemoradiotherapy and lateral lymph node dissection. The accuracy of diagnosing lateral lymph node metastasis remains poor. The size of lateral lymph nodes is still the most commonly used variable with the most consistent accuracy and the cut-off value ranging from 5 to 8 mm on short axis. The morphological features, differentiation of the primary tumor, circumferential margin, extramural venous invasion, and response to chemoradiotherapy are among other risk factors to predict lateral lymph node metastasis. Planning multiple disciplinary treatment strategies for patients with suspected nodes must consider both the risk of local recurrence and distant metastasis. Total neoadjuvant chemoradiotherapy is the most promising regimen for patients with a high risk of recurrence. Simultaneous Integrated Boost Intensity-Modulated Radiation Therapy seemingly improves the local control of positive lateral nodes. However, its impact on the safety of surgery in patients with no response to the treatment or regrowth of lateral nodes remains unclear. For patients with smaller nodes below the cut-off value or shrunken nodes after treatment, a close follow-up strategy must be performed to detect the recurrence early and perform a salvage surgery. For patients with stratified lateral lymph node metastasis risks, plans containing different multiple disciplinary treatments must be carefully designed for long-term survival and better quality of life.
Humans ; Lymphatic Metastasis/pathology* ; Quality of Life ; Neoplasm Staging ; Retrospective Studies ; Lymph Nodes/pathology* ; Rectal Neoplasms/surgery* ; Lymph Node Excision/methods* ; Neoadjuvant Therapy/methods* ; Neoplasm Recurrence, Local/surgery*

Colorectal cancer is one of the most common cancers in the world, and surgery is the mainstage treatment. Urogenital and sexual dysfunction after radical resection of rectal cancer has become an important problem for patients, which seriously affects the quality of life. Some patients give up radical surgery for rectal cancer because of the concerns about sexual and urinary dysfunction. The cause of this problem is intraoperative of injury pelvic autonomic nerve. The preservation of the hypogastric nerve during the surgery is important for the male ejaculation. Pelvic splanchnic nerves are mainly responsible for the male erection. The anatomical origin, distribution, and urogenital function of these two nerves are detailed described in this article. At the same time, this article introduces the classification, key points of the operation and the evaluation of autonomic nerve preservation surgery. With the rapid development of minimally invasive surgery, performing radical surgery for rectal cancer is important, we also need to fully understand the anatomical concept of pelvic autonomic nerves, and apply modern minimally invasive surgical techniques to preserve the patient's pelvic autonomic nerves as well. It is an compulsory course and an important manifestation for the standardization of rectal cancer surgery.
Humans ; Male ; Clinical Relevance ; Quality of Life ; Autonomic Pathways/surgery* ; Rectal Neoplasms/surgery* ; Pelvis/innervation*