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Cancer Genomics and Diagnostics / Colorectal Cancer Treatments and Studies / Colorectal Cancer Surgical Treatments · Journal article
Frontiers in Oncology · September 9, 2026
A consensus or society position rather than new primary data.
This narrative review synthesizes evidence on molecularly informed preoperative and response-adapted management of colorectal cancer, distinguishing five treatment strategies (neoadjuvant chemotherapy for high-risk colon cancer, TNT and organ preservation for rectal cancer, immunotherapy for dMMR/MSI-H disease, and perioperative treatment for CRLM) by intent and maturity. The authors emphasize that moving treatment earlier requires defined clinical scenario, therapeutic aim, evidence level, reassessment plan, and salvage pathway before initiation.
Narrative review. Colorectal cancer patients across localized, advanced, and metastatic disease; molecular phenotypes include dMMR/MSI-H, RAS/BRAF, HER2 status, and ctDNA.. Intervention: Preoperative strategies: selective neoadjuvant chemotherapy, total neoadjuvant therapy, response-adapted organ preservation, immunotherapy for dMMR/MSI-H disease, perioperative or conversion treatment for CRLM..
Five clinically distinct preoperative strategies now replace one uniform pathway: selective neoadjuvant chemotherapy, TNT, response-adapted organ preservation, immunotherapy for dMMR/MSI-H disease, and perioperative treatment for CRLM. MMR/MSI status has direct treatment relevance in localized disease; RAS/BRAF and tumor sidedness mainly inform metastatic and conversion strategies. HER2-directed treatment remains supported principally by advanced-disease data; ctDNA, radiomics, and dynamic tools remain adjunctive or investigational for most preoperative decisions.
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should adopt response-adapted, molecularly informed approaches to preoperative colorectal cancer management, but only after defining clinical scenario, therapeutic aim, evidence maturity, reassessment strategy, and salvage options. This guidance deemphasizes uniform pathways and emphasizes tailoring by molecular profile and expected outcome.
This is a narrative review synthesizing evidence across multiple preoperative colorectal cancer strategies, providing decision boundaries and clinical recommendations rather than reporting original trial data.
As stated by the source record.
Clinicians should adopt response-adapted, molecularly informed approaches to preoperative colorectal cancer management, but only after defining clinical scenario, therapeutic aim, evidence maturity, reassessment strategy, and salvage options. This guidance deemphasizes uniform pathways and emphasizes tailoring by molecular profile and expected outcome.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Treatment delivered before surgery in colorectal cancer now encompasses several clinically distinct strategies rather than one uniform pathway. These include selective neoadjuvant chemotherapy for radiologically high-risk colon cancer, total neoadjuvant therapy (TNT) and response-adapted organ preservation in rectal cancer, immunotherapy for mismatch repair-deficient or microsatellite instability-high (dMMR/MSI-H) disease, and perioperative or conversion treatment for colorectal liver metastases (CRLM). This Review separates these settings by treatment intent, expected endpoint, likelihood of surgery, and evidence maturity. MMR/MSI has direct treatment relevance in localized disease; RAS/BRAF status and primary tumor sidedness mainly inform metastatic and conversion strategies; HER2-directed treatment remains supported principally by advanced-disease data; and circulating tumor DNA (ctDNA), radiomics, and other dynamic tools remain adjunctive or investigational for most preoperative decisions. Quantitative results from pivotal trials are summarized alongside practical decision boundaries, including clinical complete response assessment, watch-and-wait surveillance, CRLM resectability reassessment, and stopping rules. The central message is deliberately cautious: moving treatment earlier is useful only when the clinical scenario, therapeutic aim, evidence level, reassessment plan, and salvage pathway are defined before treatment begins.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.