Surgery is an essential part of rectal cancer treatment. Radiation therapy and medical treatments are not enough for rectal adenocarcinoma, like in squamous cell carcinoma of several organs to do the curative treatment. Depending on the stage it is involved in curative or palliative treatment. In Africa, in centers with a high therapeutic arsenal, patients usually come to locally advanced stages. At Dakar Joliot Curie Cancer Institute, in a series of 50 patients operated for rectal cancer, neoadjuvant chemoradiotherapy was performed in 56% of cases and abdominoperineal amputation in 58% of cases. All patients were operated on by laparotomy. The results are limited by the difficult access to standards and innovative treatments. Total excision of the mesorectum is a carcinological and functional imperative. The preservation of the sphincter by an intersphincteric resection should be more practiced. The approach is opened upwards or more recently trans-anally in low-lying cancers. Low anastomoses are facilitated by mechanical methods. The laparoscopic approach does not modify the oncological results and improves the patient and surgeon’s comfort. This comfort increases with robotic-assisted resection whose use is limited by the cost in Africa.

Rectal Cancer incidence and mortality is thought to be on the rise in Africa. Colorectal cancer ranks 4th in Africa with an estimated incidence of 62000 new cases in 2018. Of these, 24000 were rectal cancer and out of these, 19000 (80%) were in sub-Saharan Africa (SSA). A huge gap remains in SSA to offer meaningful and effective treatment to this growing population of rectal cancer patients. A multidisciplinary approach is mandatory in rectal cancer management. This often includes a radiation/clinical oncologist, bowel surgeon, medical oncologist among others. Systemic therapy continues to remain crucial to the successful treatment of rectal cancer. This includes the neoadjuvant, adjuvant and metastatic settings. This presentation will focus on highlighting the updated standard of care in these three settings citing the rationale and recent clinical data. I will highlight the history and evolution of systemic therapy and compare the three major treatment guidelines ASCO, NCCN and ESMO. I will share my experience treating rectal cancer patients from a medical oncologists’ perspective in Kenya. I will cover how rectal cancer treatment in Kenya has evolved over time, compare public vs private settings, its challenges and highlight some of the positive strides Kenya has made to improve cancer care in general and finally give my recommendations for what Africa can do to improve systemic treatment for rectal cancer.