[Surgery for colorectal cancer in the era of individualized treatment : The new German S3 guideline on colorectal cancer].

The current German S3 guidelines on colorectal cancer reflect the increasing individualization of treatment and include several changes of direct relevance to surgical practice. Pretherapeutic diagnostics increasingly serve as risk stratification and treatment planning. Computed tomography of the chest and abdomen is now part of the standard diagnostic work-up, while structured pelvic magnetic resonance imaging plays a central role in rectal cancer. Determination of the mismatch repair deficiency/microsatellite instability (dMMR/MSI) status is recommended before initiation of treatment and can fundamentally alter the treatment strategy, particularly in rectal cancer. Minimally invasive surgical procedures are explicitly recommended and complete mesocolic excision is emphasized as a surgical principle in colon cancer. In rectal cancer, organ-preserving treatment strategies need to be considered as part of interdisciplinary treatment planning before proceeding to surgery. For patients requiring resection, partial and total mesorectal excision remain the surgical standards; however, several recommendations, including those concerning extralevator abdominoperineal excision, perineal reconstruction and full-thickness local excision of early rectal cancer, require careful interpretation in the context of the underlying evidence. Follow-up strategies have also become increasingly more individualized. In addition to detection of recurrence, structured watch and wait protocols following organ-preserving treatment and the systematic assessment and management of long-term functional sequelae after rectal cancer surgery are gaining importance. Overall, the new guidelines mark a shift from standardized treatment pathways towards risk-adapted, interdisciplinary and shared decision-making in colorectal cancer treatment.