[Local recurrence after surgery for cancer of the rectum]

Local tumor recurrence rates after curative rectal cancer surgery are reportedly high and herald a poor diagnosis. Extramural recurrence is most common and is due to the failure to remove all of the tumor during the initial operation. In the rarer anastomotic recurrence, the implantation of exfoliated malignant cells is possible, but histochemical changes in the mucosa surrounding a tumor may be considered as an alternative cause of local recurrence. Local recurrence rates did not improve when the distal margins were extended over 2 cm, but microscopic lateral tumor extension appears to be the major determinant of recurrence. Early diagnosis is based on frequent CEA assays, history, physical examination, endoscopy, endoluminal ultrasound and pelvic CT scan. Aggressive treatment involving a combination of field irradiation, surgical debulking and intra-operative radiation can result in local control and long-term survival in 10 to 25% of patients.