Decision making, treatment planning and technical considerations in patients undergoing surgery for locally recurrent rectal cancer

Abstract

The oncological outcomes of patients with locally recurrent rectal cancer (LRRC) have improved dramatically in recent decades due to the evolution of extended radical surgical techniques and the development of expert multi-disciplinary teams at specialist units. LRRC is now considered a salvageable and potentially curable situation in selected patients. Careful patient selection and meticulous treatment planning should be developed in a multi-disciplinary setting, where consideration is given to the ability to achieve clear resection margins, the presence of unresectable metastatic disease, the potential morbidity and functional outcomes associated with radical surgery and the impact on quality of life, as well as the individual patient's goals and treatment priorities. Radical multi-visceral resection is the cornerstone of treatment and clear (R0) margins is the most important predictor of long term survival, which can be expected in 40–50% of patients if R0 resection is achieved. The development of radical techniques for lateral neurovascular and composite bony resections have facilitated improved R0 resection rates at the periphery of the pelvis giving a larger number of patients the chance of cure. Teamwork and preparation are critical when undertaking complex multi-visceral pelvic resections with input from urological, vascular, plastic and orthopaedic surgeons, particularly during the reconstruction phase.