This protocol covers rectal cancer that is appropriate for surgical resection at clinical stage T1–2, N0 — localised disease with no regional lymph node involvement, confirmed by pelvic MRI or endorectal ultrasound prior to surgery.
Patients with rectal cancer suitable for resection presenting at clinical stage T1–2, N0. Staging must be established by pelvic MRI (preferred) or endorectal ultrasound; there is no evidence of lymph node involvement at initial presentation.
Following resection, adjuvant management is individualised according to final pathologic stage. Certain pathologic outcomes are managed with observation alone; other findings lead to perioperative regimens involving chemotherapy and radiation therapy in a specified sequence — up to 6 months in duration. The full decision framework, including which pathologic scenarios require which combination, is set out in the complete protocol.