There is extensive rectal and peritoneal malignancy with multiple adverse features.
The lowest portion of the circumferential tumour is 5 cm from the anal verge, and extends over a length of approximately 12 cm, from the lower rectum up to the sigmoid.
There is unequivocal infiltration through the muscularis propria. Anteriorly, the tumour infiltrates the anterior mesorectal fascia. The tumour has penetrated into the peritoneal reflection with gross peritoneal thickening noted.
There are multiple heterogenous mesorectal nodes and nodes along the draining vascular pedicle. There is evidence of EMVI.
Radiological staging is T4, N2, M1, EMVI positive, CRM involved