Comparative Radiological and Surgical Approaches in the Early Detection and Treatment of Colorectal Cancer: A Systematic Review

One of the biggest causes of cancer mortality is still colorectal cancer (CRC), and outcomes depend heavily on timely detection, accurate staging, and curative-intent intervention, having been among the top five causes of cancer-related death globally since 1990 and, as of 2023, the leading cause of cancer-related death in individuals under 50. Evidence comparing radiological and surgical strategies remains fragmented across screening, staging, and treatment pathways, limiting direct translation into unified clinical workflows. This review aimed to compare the diagnostic and clinical utility of major imaging modalities with outcomes of surgical approaches used in early-stage CRC. A systematic search of electronic databases was conducted using MeSH and free-text terms, restricted to English-language human studies published between 2015 and 2025. Randomised trials and observational comparative studies were included, with data extracted on imaging accuracy, staging concordance, perioperative outcomes, recurrence, and survival, followed by narrative synthesis due to heterogeneity. Key outcomes showed CT colonography as a feasible screening alternative with cost-effectiveness dependent on participation, pelvic MRI as central for rectal staging and restaging, and PET-based techniques contributing mainly to surveillance and metastatic assessment. Surgical evidence supported minimally invasive colectomy and organ-preserving rectal pathways in selected patients, while emphasising morbidity risks and recurrence trade-offs. These findings support multidisciplinary integration of imaging-guided stratification with tailored surgical planning and biomarker-informed escalation or de-escalation. Limitations included variable protocols and inconsistent endpoint reporting. Precision imaging combined with appropriate surgery remains the most actionable strategy for improving early CRC outcomes.