[Surgical possibilities in recurrence of colorectal carcinoma]

Locoregional recurrences occur in 10 to 15% of curatively operated rectal carcinomas. Technically conditioned relapses can be largely avoided by proper procedure, such as taking into consideration the localisation, staging, grading, safety zones and step-by-step procedure, e.g. "no-touch-isolation" technique, radicular approach and rinsing with cytocides. In this manner, locoregional relapses can be reduced to about 10%. Only technically conditioned relapses can be cured by surgery, but, as already stated above, these should be avoided by an appropriate technique. It is quite out of place to indulge in euphoria in respect of treating locoregional recurrences, as shown by long-term examination of actual survival rates; calculated survival rates are certainly inappropriate for spreading euphoria. Such locoregional relapses can be recognised relatively early and reoperated "curatively" only if aftercare follow-up is regular and intensive. It seems that endorectal sonography is of special diagnostic importance for the early detection of relapses while being a relatively simple method. It must be stated quite clearly that efficient preventive measures during the first operation will be much more effective than any efforts put into follow-up or aftercare. Every surgeon should therefore know that it is imperative to proceed subtly and carefully during the first operation so as to avoid any relapses due to faulty technique, the more so since all relapses have a poor prognosis even with so-called "curative" operations.