Locally Advanced and Recurrent Rectal Cancer (2nd Edition)

Dear Colleagues,

This collection is the second edition of the Special Issue “Locally Advanced and Recurrent Rectal Cancer” (https://0-www-mdpi-com.brum.beds.ac.uk/journal/cancers/special_issues/Recurrent_Rectal_Cancer).

Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. The adequate preoperative imaging of the pelvis is therefore important for identifying those patients that are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. A lot of effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity as well as mortality and improve long-term survival rates. Not only volume, but a multidisciplinary team, including a radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist, is also of importance in these surgical procedures. Traditionally, peritoneal carcinomatosis, high sacral involvement, the encasement of external iliac vessels, the invasion of the sciatic notch, bilateral ureteral obstruction with bilateral hydronephrosis, and the presence of gross lower limb edema (in addition to unresectable distant metastases) were considered absolute contraindications to pelvic exenteration surgery. Many of these dogmas have been challenged as exenteration centers around the world extend the traditional boundaries of resection.

The past two to three decades, however, have seen the increasing acceptance of pelvic exenteration for patients with isolated locally recurrent rectal cancer because of the number of studies demonstrating reduced operative mortality and improved overall survival in large case series as well as quality of life outcomes. Long-term survivors after pelvic exenteration for local recurrence have a comparable quality of life to patients who had primary rectal cancer. Several studies have demonstrated that the quality of life of pelvic exenteration patients was preserved compared to patients who underwent palliative treatment. These radical surgical approaches have previously been controversial in the surgical literature, but are no longer controversial in view of the strong and overwhelming evidence that suggests that the R0 resection margin is the main predictor of long-term survival.

The aim of this Special Issue is to provide an update on articles focused on the evolution and future of multimodal therapy for locally recurrent rectal cancer.

Prof. Dr. Jean-Jacques Tuech
Guest Editor

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• rectal cancer
• rectal imaging
• chemoradiation
• advanced rectal cancer
• locally recurrent rectal cancer
• multimodal treatment
• neoadjuvant chemoradiation
• prehabilitation
• pelvic exenteration
• multivisceral resection
• pelvic reconstruction
• urinary reconstruction
• rehabilitation
• quality of life
• palliative surgery