对于直肠癌患者，化疗、放射治疗 (RT) 和手术（三联疗法，TMT）的标准方法与大多数患者的显着长期毒性和/或结肠造口术相关。注重生活质量 (QOL) 的患者选择已显着改善，但有关比较有效性的指导仍然有限。本系统综述和相关指南评估了不同治疗策略在肿瘤学结果和生活质量方面如何相互比较。Cochrane 和 PRISMA 方法用于在 Ovid Medline 数据库中搜索具有足够质量的前瞻性和回顾性试验以及荟萃分析 1 /1/2012-6/15/2023。这些研究为专家小组提供了信息，专家小组通过完善的共识方法（修改后的 Delphi）对 6 种临床情况下的各种治疗方法的适当性进行了评估。搜索过程产生了 197 篇建议投票的文章。越来越多的数据显示，与 TMT 相比，非手术治疗 (NOM) 和初次手术可带来生活质量改善，且不会损害肿瘤学结果。对于 TME 会导致永久性结肠造口术或肠失禁不足的直肠癌患者，强烈建议通常情况下适当使用 NOM。 RT/CRT 完成后 8-12 周进行肿瘤反应评估重新分期被认为是 NOM 的必要组成部分。专家组建议在接近完全或完全响应的情况下进行主动监测。在 NOM 情况下，建议 27-33 次化疗同时进行 54-56 Gy，然后进行巩固化疗。专家组强烈建议对 T3N0 高位直肠肿瘤进行初次手术，对于 T3N0 高位直肠肿瘤，LAR 和足够的肠功能是可能的，如果 N 则考虑辅助化疗。最近的数据支持 NOM 和初次手术作为应向符合条件的患者提供的重要选择。考虑到多学科管理的复杂性，应在多学科环境中对患者进行讨论，并且应根据患者个体目标/价值观制定治疗方案。版权所有 © 2024。由 Elsevier Inc. 出版。

For rectal cancer patients, the standard approach of chemotherapy, radiation therapy (RT), and surgery (Trimodality Therapy, TMT) is associated with significant long-term toxicity and/or colostomy for most patients. Patient options focused on quality-of-life (QOL) have dramatically improved, but there remains limited guidance regarding comparative effectiveness. This systematic review and associated guidelines evaluate how various treatment strategies compare to each other in terms of oncologic outcomes and QOL.Cochrane and PRISMA methodology were used to search for prospective and retrospective trials and meta-analyses of adequate quality within the Ovid Medline database between 1/1/2012-6/15/2023. These studies informed the expert panel, which rated the appropriateness of various treatments in 6 clinical scenarios through a well-established consensus methodology (modified Delphi).The search process yielded 197 articles that advised voting. Increasing data show non-operative management (NOM) and primary surgery result in QOL benefits noted over TMT without detriment to oncologic outcomes. For rectal cancer patients for whom TME would result in permanent colostomy or inadequate bowel continence, NOM was strongly recommended as usually appropriate. Restaging with tumor response assessment 8-12 weeks following completion of RT/CRT was deemed a necessary component of NOM. The panel recommended active surveillance in the setting of a near complete or complete response. In the setting of NOM, 54-56 Gy in 27-33 fractions concurrent with chemotherapy and followed by consolidation chemotherapy was recommended. The panel strongly recommends primary surgery as usually appropriate for a T3N0 high rectal tumor for whom LAR and adequate bowel function is possible, with adjuvant chemotherapy considered if N+.Recent data supports NOM and primary surgery as important options that should be offered to eligible patients. Considering the complexity of multi-disciplinary management, patients should be discussed in a multi-disciplinary setting and therapy should be tailored to individual patient goals/values.Copyright © 2024. Published by Elsevier Inc.