The Management of Inoperable Rectal Cancer

Rectal cancer accounts for more than 160,000 global cancer deaths per annum with over 10,000 new cases diagnosed each year in the United Kingom [1]. Over recent years an increased interest in the management of rectal cancer has occurred as a consequence of the debate surrounding the incidence of local recurrence following resection of primary rectal tumours and the adoption of total mesorectal excision (TME) [2,3].The TME debate has led to a heightened awareness of the variability of outcome following treatment of rectal cancer but has also prompted greater interest in preoperative local staging of the disease. The recognition and assessment of advanced tumours has been supported by major improvements in radiological imaging, allowing more objective determinants of staging and better planning for multimodality treatment [4]. Whether an advanced tumour is deemed resectable is subject to many variables but the consequences of a surgeon labeling a patient inoperable are profound. Living with a rectal cancer in situ, especially in the absence of metastatic disease, inevitably leads to a miserable state of uncontrollable pain, tenesmus, discharge, and infection. The importance of careful preoperative assessment, awareness of therapies that may downstage the tumour, and an understanding of the potential and pitfalls of radical surgical resection need to be explored.