Colorectal cancer is widely prevalent and remains one of the leading causes of cancer related deaths in Saskatchewan.The incidence of local recurrence after rectal cancer treatment is improving with better imaging techniques, preoperative neoadjuvant therapy and enhanced surgical techniques.Management of patients with recurrent or advanced rectal cancer, when the primary tumor involves the adjacent organs is a challenging task that necessitates the development of a multidisciplinary management including neoadjuvant chemo radiation techniques complemented with advanced surgical techniques.