Timing to Minimally Invasive Surgery After Neoadjuvant Chemoradiotherapy for Rectal Cancer

Prior treatment

• Previous radiation treatment on the pelvis
• Previous tumors other than non-melanoma skin cancer, papillary or follicular thyroid cancer

Other illness

• Metastatic disease
• Synchronous colorectal tumors requiring multi-segment surgical resection (n.b. a benign lesion within the resection field in addition to the main cancer would not exclude a patient)
• History of psychiatric or addictive disorder or other medical condition that, in the opinion of the investigator, would preclude the patient from meeting the trial requirements
• Inflammatory bowel disease
• Hereditary colorectal disease
• Participation in another rectal cancer clinical trial relating to the topic of this trial

Other

• Squamous carcinoma of the anal canal
• Pregnancy
• Unable to complete neoadjuvant treatment
• Unable to give free informed consent

• Age \>18 years
• cT3/4N0/+M0 confirmed on CT-scan, MRI (stratification for T3a-b-c-d) 3
• Tumor starting from the distal or medium rectum (even those crossing the peritoneal reflection at distal margin, within 15 cm from the anal margin)
• Histologically-proven adenocarcinoma of the rectum
• Eligible for a resective surgery with TME (low anterior resection, intersphincteric resection, abdominoperineal resection)
• Eligible for resection by minimally-invasive surgery (standard or robotic-assisted laparoscopic procedure, all robotic systems will be accepted)
• Eligible for chemoradiation treatment
• Able to give written informed consent
• Capable of completing required questionnaires at time of consent (provided questionnaires are available in a language spoke fluently by the participant)