Aggressive surgical management of locally advanced primary and recurrent rectal cancer. Current status and future directions.

Patients with locally advanced primary and recurrent rectal cancer without gross evidence of extrapelvic cancer represent a complex challenge to the surgeon. In selected patients, radical incontinuity resection or resection combined with radical radiation therapy offers a high likelihood of local tumor control and, to a lesser degree, the possibility of cure. This article defines current approaches to the aggressive management of such patients and investigative strategies for the future.