This book analyzes all aspects of modern multimodal treatment of locally recurrent rectal cancer in the pelvis in order to offer a panoramic overview of the different therapeutic options and enable the reader to balance their benefits and drawbacks. Indications for surgery and the surgical techniques themselves, including reconstruction techniques after major exenterative surgery, are clearly described and evaluated. The role of new imaging tools, such as MRI and PET-CT, in staging recurrences and guiding therapy is assessed and detailed consideration is given to the use of neoadjuvant and iterative radiotherapy and the indications for systemic chemotherapy. Morbidity, mortality, oncologic outcomes, and quality of life issues are carefully analyzed and options for pain control and palliation are examined. Finally, a national survey is presented on the state of the art in the surgical treatment of locally recurrent rectal cancer in Italy. While there has been a dramatic fall in the incidence of local pelvic recurrences, their treatment remains a major clinical challenge which requires a multidisciplinary approach and careful selection of the most appropriate strategy in each case. This book will aid practitioners in making the correct decisions in individual patients.


Giovanni Maria Romano is Chief Department of Abdominal Oncology and Consultant surgeon at the National Cancer Institute, Naples, Italy. He’s Professor of surgery at the post-graduate School of surgery of the University Federico II and at the SUN University of Naples, Italy. Tutor in Surgical Training at the Moscati Teaching hospital in Avellino, Italy. He’s also coordinator of local training workshops for the Italian Society of Colorectal Surgery all over Italy and Professor of surgery at the University of Rome in the current Master of 2th level in colorectal surgery. He is currently Past President of the European Society of Colon Proctology (ESCP), Past President of the Italian Society of Colorectal Surgery and an active member of several national and international Scientific Societies. He has been recently nominated Visiting Professor at the University of Lodz in Polland. Author of more than 300 scientific publications (90 papers in international peer reviewed journals). Referee for Techniques in Coloproctology and Colorectal Disease. Member of the Editorial Board of Techniques in Coloproctology and Rivista Italiana di Coloproctologia. From 2013 he is member of the Editorial Board of Colorectal Disease.Prof. Romano’s main scientific interests have included kidney and liver transplantation, neoplastic, inflammatory and functional diseases of the colon rectum and anus.