Current and future perspectives in the management and treatment of colorectal cancer

Table 1 Treatment options for resectable colorectal cancer

Treatment modality	Description	Additional comments
Surgery	Laparoscopic surgery, robotic surgery and navigation surgery	Laparoscopic surgery: Reduced infection risk compared to open surgery; Robotic surgery: Improved precision, dexterity, lymph node dissection; Navigation surgery: Real-time blood flow visualization, useful for lymph node mapping
Radiotherapy in resectable patients	Adaptive radiotherapy adjusts treatment in real time; Image-guided radiotherapy; Volumetric arc modulation; Intraoperative radiotherapy; Magnetic resonance-guided radiotherapy	Modalities used for tumor reduction and preoperative microscopic disease in resectable rectal cancer; Advanced techniques improve precision and minimize toxicities
Total neoadjuvant therapy	Combines radiotherapy and preoperative chemotherapy to improve local control and reduce the risk of metastasis	Indicated for locally advanced rectal cancer (cT3, cT4 or N +); It improves the rate of complete pathological response and can avoid surgery in selected cases with complete response, favoring wait and see
Adjuvant chemotherapy	Indicated in high-risk stages II and in stages III after surgery; Fluoropyrimidines + oxaliplatin	Improves disease-free survival by eliminating residual tumor cells; Sequentially in postoperative treatment is key to reducing the risk of recurrence
Immunotherapy	Currently under investigation for locally advanced MSI-H/dMMR cancer in the neoadjuvant setting	Pembrolizumab and nivolumab are being studied in clinical trials but are not used as standard in resectable non-MSI-H/dMMR disease
Circulating tumor DNA	Biomarker used to detect minimal residual disease after curative treatment	It helps to identify patients at high risk of relapse and decide on the use of adjuvant chemotherapy after surgery

MSI-H/dMMR: High microsatellite instability/deficient mismatch repair.