[Local recurrence after radical surgery for rectal carcinoma]

Area of Science:

• Oncology
• Surgical Gastroenterology
• Medical Research

Context:

• Local recurrence after radical rectal cancer surgery presents a persistent clinical problem.
• A comprehensive analysis of 86 scientific publications addresses this issue over a 20-year period.
• Despite advancements, the incidence of local rectal carcinoma relapses has not shown a decreasing trend.

Purpose:

• To comprehensively analyze the incidence, risk factors, early diagnosis methods, and surgical therapeutic approaches for local recurrences after radical rectal cancer surgery.
• To evaluate the long-term trends in local recurrence rates.
• To identify key factors influencing recurrence and assess current management strategies.

Summary:

• Risk factors for local recurrence are categorized into primary tumor characteristics (location, stage, spread, differentiation, genetics) and operative factors (technique, resection margins, total mesorectal excision, lymphadenectomy).
• Early diagnosis relies on rectoscopy/coloscopy, endo-ultrasonography with biopsy, tumor markers, and immunoscintigraphy.
• Surgical management for recurrence is increasingly aggressive, involving re-resection, abdomino-perineal extirpation, en-bloc resections, and pelvic exenteration, achieving a 5-year survival rate of 54.5%.

Impact:

• Highlights the persistent challenge of local rectal cancer recurrence, underscoring the need for refined surgical techniques and diagnostic protocols.
• Provides a framework for understanding risk factors and guides the selection of appropriate early diagnostic and aggressive surgical interventions.
• Contributes to the body of knowledge on rectal cancer management, potentially improving patient outcomes and survival rates through optimized treatment strategies.