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Key Learning Points David James In recent times, the management of rectal cancer has evolved and a multimodal approach utilising selective combinations of chemotherapy, radiotherapy and surgery are employed. Surgery may be local excision or proctectomy which in turn can be open, laparoscopic or robotic. Improvement in neoadjuvant treatment has demonstrated that some patients ultimately do not need to undergo surgery or may only require local excision of their tumour. However, this is a complex field where many treatment options exist and selecting the correct approach is reliant on accurate pre-operative staging and then tailoring treatments to each individual patient. It is imperative that patients are informed of the advantages and disadvantages of each approach allowing them to make an informed decision based on the evidence. It is also crucial that in treating rectal cancer, the surgical team has all these tools in their armamentarium in order to treat all stages of the disease. In the present case, the patient underwent maximal neoadjuvant treatment with chemotherapy and chemoradiotherapy and ultimately required pelvic exenteration. The decision making in this process is truly multidisciplinary and requires many specialties and allied health teams to support the patient through this process.

Surgical resection for rectal cancer: a gold standard or a last-resort?