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Summary Box

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 Early delivery of high-dose systemic chemotherapy represents a promising treatment strategy for both LARC and LRRC.

 Favorable short-term outcomes include improved chemotherapy compliance and superior pathological response.

 Long-term survival data are limited and interpretation is hampered by marked heterogeneity among neoadjuvant/adjuvant treatment regimes.

 Prospective randomized trials will determine whether this approach can improve distant disease control and quality of life, and increase the proportion of patients suitable for non-operative management.

 With increasing emphasis on personalized care, the future of rectal cancer management should include risk-adapted strategies incorporating the biomolecular and radiological profile of the tumor.

Surgical Management of Advanced Pelvic Cancer

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