Modern management of colorectal cancer

Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently, only two academic general surgery departments included a specialist colorectal unit, and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with, and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality, with poor oncological outcomes. Repeatedly, outcome has been shown to be worse in the hands of generalists, rather than specialist colorectal surgeons, of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers.