Locally advanced and locally recurrent rectal cancers (LARC/ LRRC) represent two distinct clinical entities, yet they pose the single greatest challenge to colorectal surgeons, namely obtaining a negative resection margin in the presence of complex, advanced disease. Neoadjuvant radiotherapy can facilitate downstaging of advanced tumours, and improved local control is well documented [1][2][3][4]. Unfortunately, a proportion of patients will have threatened margins making a complete resection (R0) difficult. Where rectal
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