Surgical management of the locally advanced pelvic malignancy--the colorectal surgeon's view

About 10% of patients with newly diagnosed colorectal cancer will have locally advanced disease without gross evidence of distant or discontiguous intraabdominal metastases. Long-term cure or disease-free survival frequently follows extended resection for a locally advanced primary colorectal carcinoma. The use of adjuvant combined chemo-radiation therapy is still being evaluated. While complete resection of recurrent disease sometimes provides the best long-term survival when compared with other treatment modalities, few patients are suitable candidates for curative resection. In our experience, major extended resection for recurrent pelvic disease is largely palliative and is rarely associated with long-term survival.