Locally Advanced and Recurrent Rectal Cancer

Dear Colleagues,

Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. Much effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity and mortality and improve long-term survival rates. Not only volume, but also a multidisciplinary team, including a radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist is of importance in these surgical procedures. Traditionally, peritoneal carcinomatosis, high sacral involvement, encasement of external iliac vessels, 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 exenterative surgery. Many of these dogmas have been challenged as exenterative centers around the world extend the traditional boundaries of resection.

The past two to three decades, however, have seen 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 comparable quality of life to patients who had primary rectal cancer. Several studies demonstrated that quality of life in 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 R0 resection margin is the main predictor of long-term survival.

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

Prof. Dr. Jean-Jacques Tuech
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.