Colorectal cancer – heading to the future

Colorectal cancer is one of the most frequently occurring malignancies worldwide, with about 1.4 million newly diagnosed cases per year. Rather a lot of innovations have been realized and implemented into daily practice just over the last 30 years, changing the diagnostic and therapeutic options and tremendously improving oncologic outcomes. Previously, surgery was mainly performed on a low-quality, non-standardized level; chemotherapy still had little effect on the treatment of distant metastases; and radiotherapy was mainly reserved for desperate cases. Imaging was more or less an obscure than a reproducible method, leaving room for broad personal interpretations. These have definitely changed.

Mainly standardization of surgery [1, 2], but also improvement of radiotherapy [3, 4] and imaging [5], as well as effective systematic treatment based on advanced knowledge of tumor cell biology [6, 7] have each contributed to increasing survival, which has currently reached a median of >2 years even in patients with distant metastases.

Further improvement may be expected. More stratified and accurate treatment will be primarily based on improved imaging unless molecular staging will change everything. Modern imaging technology will not only detect distant metastases more precisely, but will also allow allocating patients with colon cancer to neoadjuvant treatment [8].

The implementation of high-quality rectal cancer surgery is probably widely realized. This is, however, not true concerning complete mesocolic excision for colon cancer. This concept is technically and intellectually more demanding, even more if laparoscopic surgery is considered. The use of robotic surgery is rapidly spreading. However, its assessment is still unclear and further evaluation is needed. In the course of minimizing the access for removing colorectal tumors, endoscopic routes are increasingly being used. However, these procedures are also technically demanding. Their overall assessment, including quality of life, may it be better or worse, is not even considered or planned. Unexpectedly, tumor removal is sometimes no longer necessary if neoadjuvant irradiation had led to a complete remission. It is not yet decided whether it will be taken only as a positive side effect of radiochemotherapy indicated for better local control of advanced rectal cancer, or as part of future concepts as an alternative option in less advanced cases, with the aim to increase complete remissions. As quality of life and long-term negative side effects have to be considered in the future more seriously, the indication of each of these interventional innovations will have to be weighed against its specific risks and advantages.

Of course, there are even more “hot topics” in the field of innovations in the treatment of colorectal cancer, not touched in this issue, like neoadjuvant chemotherapy of colon cancer, as well as omitting adjuvant chemotherapy after optimized surgery in selected cases [9], modifications of hyperthermic intraperitoneal chemotherapy, or even aspects of quality of life.

Finally, the mission to improve colorectal cancer treatment is still far from completion. Further innovations will continue to achieve better and better results. All disciplines will have to contribute, watching and respecting the progress of all fields of colorectal cancer care and including them into the decision-making process.

On behalf of the Editorial Board, I would like to thank all authors for their contributions. In this respect, we are very grateful that all colleagues – despite the invitation to submit a paper – agreed to the double-blind peer-review process established for Innovative Surgical Sciences. The Editorial Board and the publisher DeGruyter think that this will foster the necessary steps toward transparency in scientific publication. We all hope that this special issue with emphasis on certain contemporary aspects of colorectal cancer fulfills the expectations of our readers. We will be happy to publish Letters to the Editor.