治疗指南属于最权威的循证医学来源，并被医疗保健提供者广泛实施。全球每年有超过 730,000 例新发病例和近 340,000 例死亡的直肠癌仍然是一个重大的治疗挑战。全直肠系膜切除术（TME）显着改善了局部控制。已提议添加新辅助治疗以提供进一步的进展。然而，这种添加会导致显着的功能障碍和生活质量下降。本综述严格评估了当前国际指南中新辅助治疗的建议是否得到证实。 2022 年 7 月，PubMed 进行了全面检索，结果在 2012 年至 2022 年间以英文发表了 988 篇论文。排除和证明后，仍有 19 篇文献需要进一步分析。在本次综述考虑的 19 条指南中，11 条不建议进行前期手术，并且12 没有解决多模式治疗后的功能障碍问题。新辅助治疗的建议依赖于过时的参考文献，缺乏基于当前 MRI 分期使用的差异化策略；许多指南也建议对可能不需要这种治疗的患者亚组进行新辅助治疗。此外，通常不会提出有关利益冲突的声明。需要立即采取必要措施，使建议与最新的现有证据保持一致，从而为直肠癌患者提供相应的护理标准。对指南制定过​​程进行细致评估有可能避免未来的异质性。© 2024。作者。

 Treatment guidelines belong to the most authoritative sources of evidence-based medicine and are widely implemented by health-care providers. Rectal cancer with an annual incidence of over 730,000 new cases and nearly 340,000 deaths worldwide, remains a significant therapeutic challenge. The total mesorectal excision (TME) leads to a dramatic improvement of local control. The addition of neoadjuvant treatment has been proposed to offer further advancement. However, this addition results in significant functional impairment and a decline in the quality of life.This review critically assesses whether the recommendation for neoadjuvant treatment in current international guidelines is substantiated. A comprehensive search was conducted in July 2022 in PubMed resulting in 988 papers published in English between 2012 and 2022. After exclusions and proofs 19 documents remained for further analysis.Of the 19 guidelines considered in this review, 11 do not recommend upfront surgery, and 12 do not address the issue of functional impairment following multimodal treatment. The recommendation for neoadjuvant therapy relies on outdated references, lacking differentiated strategies based on current utilisation of MRI staging; numerous guidelines recommend neoadjuvant treatment also to subgroups of patients, who may not need this therapy. Also statements regarding conflicts of interest are often not presented.An immediate and imperative step is warranted to align the recommendations with the latest available evidence, thereby affording rectal cancer patients a commensurate standard of care. A meticulous assessment of the guideline formulation process has the potential to avert heterogeneity in the future.© 2024. The Author(s).