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Answer 4
  1. Surgical APR. The patient has stage III rectal cancer (positive regional lymph node involvement), thus excluding limited attempts at excision of the lesion (endoscopic approaches or surgical transanal excision). An APR is the appropriate surgery for this patient. Opinion diverges about the use of neoadjuvant or adjuvant therapy in this patient, but some additional therapy is required given his node-positive disease. A total colectomy is not required as only the rectum appears to be involved.

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