[True and false local recurrence after continence resection for rectal carcinoma--the evaluation and the mesorectum]

Our experience with 32 cases of real local relapses is presented. As pseudo recurrences we define metachchronous and residual synchronous cancer left in the ampule by mistake. The frequency of recurrence, patient factors, tumors and operative technique are discussed. Examples of the development (e.g. caused by implanting metastases from transsected lymph vessels) are presented. The special situation of the pelvic colon cancer among local recurrences is discussed. We also discuss the fact that recurrences have so far been impossible to detect in this area and local relapses have a poor prognosis. Most recurrences develop within the first two postoperative years. Only recurrences at the anastomoses have a true chance of healing permanently, and this can only be achieved with another operative procedure. Out of 27 recurrences 50% were operated on, and two of these remained free of disease. We have to strive for R0 margins of resection. The mesorectum must not always be removed at the time of the primary operation.