Advanced and Recurrent Rectal Cancer

Rectal cancer accounts for one-third of all colorectal cancers and has an increasing incidence in patients under 40 years of 1.8 to 2.6% annually. Significant advances in multidisciplinary therapy for rectal cancer have resulted in an improved relative 5-year survival; prognosis is strongly dependent on the extent of disease. Although the majority of patients present with disease localized to the mesorectum, locally advanced rectal cancer (LARC) occurs in up to 10% of patients. Surgical extirpation remains the mainstay of curative therapy for LARC and locally recurrent rectal cancer (LRRC). This review covers risk factors for pelvic recurrence, clinical presentation, diagnosis and staging, preparation for surgery, multimodality therapy for advanced and locally recurrent rectal cancer, pelvic reconstruction, and palliative procedures. Figures show Harrison-Anderson-Mick applicator for intraoperative brachytherapy, an algorithm for treating LARC (extension beyond mesorectal fascia or advanced modal disease), an algorithm for treating LRRC, and intraoperative photographs showing oblique sacral resection, extended right lateral pelvic resection, and vertical rectus myocutaneous flap pr