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Locally advanced rectal cancer (LARC) is defined as a tumour which is predicted by magnetic resonance imaging to require an extended surgical resection beyond the total mesorectal excision plane [1]. Preoperative neoadjuvant treatments are commonly utilised to downstage and downsize the tumour, facilitating resection. In patients with persistent predicted involved margins or poor response to neoadjuvant treatment, several studies and a meta-analysis have shown that intraoperative electron beam radiotherapy (IOERT) is a further useful adjunct to extended margin surgery, leading to low recurrence within the IOERT field even in patients with a positive margin [2]. Here we describe a case of LARC with anterior and pelvic sidewall involvement and predicted stage of T4N0M0 with involved circumferential resection margins. A poor radiological response to neoadjuvant therapy was noted, and the patient was subsequently treated with a posterior pelvic exenteration with en bloc pelvic sidewall resection and IOERT using the IntraOp Mobetron device (IntraOp, Sunnyvale, CA, USA). Final histology was ypT4N0 EMVI-negative R1 (pelvic sidewall margin, 0.3 mm) TRG4 (minimal response to neoadjuvant therapy). Post-operative recovery was complicated by a temporary ileus requiring parenteral nutrition. At 6-week and 3-month reviews, the patient had returned to preoperative functional status (Figs. 1, 2, 3, 4, 5, 6, 7, 8, 9).

techniques in coloproctology

Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron® for locally advanced rectal cancer