Strategies in operative therapy for locally recurrent rectal cancer

Local recurrence of rectal cancer after curative surgery is a major clinical problem. It is the primary source of overall treatment failure. The main causes of local recurrence are inadequate excision of the primary tumor or the draining lymph nodes and intraoperative tumor-cell implantation. Recurrence commonly develops within or contiguous with the operative site. Among locoregional failures, up to one third will be confined to the pelvis. Patients often present with symptomatic disease, and surgical resection remains the only option for long-term cure or palliation. Preoperative evaluation includes a thorough clinical assessment combined with imaging studies that may be helpful in obtaining histologic confirmation of recurrent cancer. In carefully selected operative candidates, the surgical approach is tailored to the pattern of recurrence. Aggressive resection with curative intent can achieve improved survival and significantly contribute to quality of life in these challenging patients.