The surgical approach to locally recurrent rectal cancer

The incidence of rectal cancer recurrence after surgery is 5-45%. Predictive factors relating to local recurrence (LR) are the surgical experience, the location of the tumour, the tumour's pathology, the circumferential margins, the successful total mesorectal excision (TME) and the use of radiochemotherapy. The use of TME and preoperative radiotherapy reduce the risk of LR. Diagnosis is done using imaging techniques. Computed tomography with rectal contrast is the preferred imaging technique. The surgical strategy for LR at and around a previous anastomosis is the resection of the anastomosis with a sphincter-saving procedure. LR isolated to one side after anterior resection is an indication for en bloc resection of the rectum with a portion of the bladder. LR fixed to the sacrum requires a composite abdominosacral resection. Extrapelvic disease is a contraindication to curative resection. The composite sacropelvic resection is a reasonable alternative to palliative radiation with long-term survival of 20-30%.