# Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Source: https://onco.cc/key-papers/paper-esmo-rectal-cancer-guideline-ann-oncol-2017/  
OnCo record `paper-esmo-rectal-cancer-guideline-ann-oncol-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The European guideline for rectal cancer: how MRI decides the treatment, when radiotherapy is given before the operation, and how the mesorectum is removed.

## Summary

ESMO Clinical Practice Guidelines for rectal cancer, published in Annals of Oncology in 2017 by Glynne-Jones, Wyrwicz, Tiret, Brown, Rödel, Cervantes and Arnold for the ESMO Guidelines Committee. Europe PMC indexes no abstract for this article, so OnCo carries no figures from it.

Its organising idea is risk stratification by MRI: the distance from the tumour or an involved node to the mesorectal fascia, extramural venous invasion and nodal status decide whether a patient has surgery alone, short-course radiotherapy, or long-course chemoradiotherapy before total mesorectal excision.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: Annals of Oncology
- Year: 2017
- DOI: 10.1093/annonc/mdx224
- Authors: Glynne-Jones R, Wyrwicz L, Tiret E, et al.
- Findings: No abstract is indexed on Europe PMC; recommendations are read from the guideline itself.
- What it means: The document behind the MRI-first rectal cancer pathway used across Europe and the UK; the total neoadjuvant therapy trials (RAPIDO, PRODIGE 23, OPRA) that came after it are the main reason an update was needed.
- Caveats: Predates RAPIDO (2021), PRODIGE 23 (2021), OPRA (2022) and the dostarlimab organ-preservation series, all of which changed what is offered before surgery.; Guideline text, not a trial.

## Sources

- Ann Oncol 2017: https://doi.org/10.1093/annonc/mdx224
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28881920/

## Connected records

- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRI](https://onco.cc/technologies/mri/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Radiotherapy](https://onco.cc/terms/radiotherapy/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- people: [Andrés Cervantes](https://onco.cc/people/andres-cervantes/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)
- key papers: [Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)](https://onco.cc/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/)

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