Pelvic recurrence of rectal cancer remains one of the most challenging issues in surgical treatment of rectal cancer. Both Japanese and Western guidelines emphasize that complete surgical resection offers the greatest chance of improving prognosis. In recent years, multidisciplinary treatment combining radiotherapy and systemic chemotherapy has also been frequently employed, with an emphasis on balancing curative potential and patient quality of life in treatment selection. Advances such as laparoscopic and robotic surgery, carbon ion radiotherapy, and novel systemic agents have further expanded therapeutic options; however, standardized strategies in Asia are still in the process of being established. This panel discussion will provide an opportunity for experts from various disciplines to share the latest practices and challenges, and to explore optimal treatment frameworks from an international perspective.