How would you manage a patient with a very large adenocarcinoma of the rectum (10 cm) that extends to the anal verge with positive peri-rectal and inguinal lymph nodes, but no distant organ involvement?   

Anyone with locoregionally confined rectal cancer that is medically operable should be considered for definitive surgery after neoadjuvant chemoradiation without any question. The survival of node positive rectal cancer based on historical data when the chemotherapy was not as active as to...