Locally advanced disease

Surgical resection is the mainstay of treatment for rectal cancers. For the vast majority of patients with rectal cancers the tumor is located within the mesorectal fascia and is resected with total mesorectal excision (TME) with excellent clinical outcomes. A small percentage of patients have tumors that extend beyond the mesorectal compartment with invasion into the fascia propria or beyond into surrounding structures or with local lymph node involvement (stage II or III). These patients with locally advanced rectal cancer are difficult to treat with surgery alone due to an increased risk in local disease recurrence. In recent years, new technologies and advances in treatment protocols have resulted in a multidisciplinary approach that has yielded improved clinical and oncological outcomes.