Irradiation and surgery for primarily inoperable rectal adenocarcinoma

Preoperative irradiation followed by radical surgical removal of the tumor should be attempted in all patients with locally advanced rectal adenocarcinomas, including patients with moderate distant metastases. If the tumor is not operable after half dose of irradiation (3150 rads), the patients should be re-explored for resectability after full irrdiation dose. Resectability can only be adequately determined by exploratory laparotomy and an attempt to resect the tumor-bearing segment by anatomic dissection, and not solely by rectal exploration or palpation of the pelvis at laparotomy.