 In patients with locally advanced rectal cancer (LARC), established risk factors for poorer outcomes include circumferential resection margin involvement, extramural depth of spread >5 mm, extramural vascular invasion (EMVI), mucinous phenotype, and poor response to chemoradiotherapy (CRT) [9,10]. Multiple studies have demonstrated relatively poor compliance with adjuvant (postoperative) chemotherapy compared with neoadjuvant treatment, with decreased survival in the adjuvant (versus neoadjuvant) cohort [11]. Prospective studies have demonstrated that preoperative or neoadjuvant radiation with or without sensitizing chemotherapy reduced local recurrence risk and may increase the proportion of patients who benefit from a sphincter-saving procedure. There is an ongoing effort to assess for complete response to neoadjuvant therapy in an effort to determine which patients could potentially benefit from an organ-preservation approach without total mesorectal excision or lateral nodal dissection. aOregon Health and Science University, Portland, Oregon. bEmory University, Atlanta, Georgia. cPanel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin. dPanel Vice-Chair, University of California San Diego, San Diego, California. eUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. fBoston University Medical Center, Boston, Massachusetts. gH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. hPRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons. iVirginia Tech Carilion School of Medicine, Roanoke, Virginia. jMassachusetts General Hospital, Boston, Massachusetts. kCleveland Clinic, Cleveland, Ohio. lSutter Medical Group, Sacramento, California. mDuke University Medical Center, Durham, North Carolina. nUniversity of Alabama at Birmingham, Birmingham, Alabama. oUniversity of California San Diego, San Diego, California.
Staging of Colorectal Cancer.  In patients with locally advanced rectal cancer (LARC), established risk factors for poorer outcomes include circumferential resection margin involvement, extramural depth of spread >5 mm, extramural vascular invasion (EMVI), mucinous phenotype, and poor response to chemoradiotherapy (CRT) [9,10]. Multiple studies have demonstrated relatively poor compliance with adjuvant (postoperative) chemotherapy compared with neoadjuvant treatment, with decreased survival in the adjuvant (versus neoadjuvant) cohort [11]. Prospective studies have demonstrated that preoperative or neoadjuvant radiation with or without sensitizing chemotherapy reduced local recurrence risk and may increase the proportion of patients who benefit from a sphincter-saving procedure. There is an ongoing effort to assess for complete response to neoadjuvant therapy in an effort to determine which patients could potentially benefit from an organ-preservation approach without total mesorectal excision or lateral nodal dissection. aOregon Health and Science University, Portland, Oregon. bEmory University, Atlanta, Georgia. cPanel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin. dPanel Vice-Chair, University of California San Diego, San Diego, California. eUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. fBoston University Medical Center, Boston, Massachusetts. gH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. hPRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons. iVirginia Tech Carilion School of Medicine, Roanoke, Virginia. jMassachusetts General Hospital, Boston, Massachusetts. kCleveland Clinic, Cleveland, Ohio. lSutter Medical Group, Sacramento, California. mDuke University Medical Center, Durham, North Carolina. nUniversity of Alabama at Birmingham, Birmingham, Alabama. oUniversity of California San Diego, San Diego, California.