This episode tackles the highly complex and morbid radical management of Locally Recurrent Rectal Cancer (LRC), a disease defined as extra-TME pathology, operating in dense, irradiated, fibrotic tissue. Achieving an R0 resection is the single biggest determinant of cure (40-50% 5-year OS). Planning requires mandatory Multidisciplinary Team (MDT) input and combined PTCT/MRI, recognizing the limitations of MRI in delineating small pelvic sidewall structures. The modern radical approach often necessitates major structural sacrifice, including internal iliac vascular resection and careful management of the sciatic nerve. A critical academic point discussed is the evolving R0 margin controversy, suggesting that margins wider than 0.1mm may not provide additional survival benefit, forcing a balance between radicality and functional outcome.