Surgical Approach to Locally Recurrent Disease

Abstract

Over the past two decades, major advances in surgery, chemoradiotherapy, and postoperative care have contributed to dramatic improvements in recovery and survival for patients with rectal cancer. Most significantly, from the surgical point of view, has been the adoption of total mesorectal excision (TME) as the standard of care. Nevertheless, some patients will recur. Locally recurrent rectal cancer is a difficult condition to manage, and long-term survival is unlikely without additional treatment. Surgery is the only potential cure. Ideally, this will involve a multidisciplinary team of specialists including medical and radiation oncologists, colorectal surgical oncologists, urologic surgeons, gynecologic surgeons, plastic and reconstructive surgeons, orthopedic surgeons, vascular surgeons, and possibly neurologic surgeons. However, surgical treatment of recurrent rectal cancer should be undertaken only in carefully selected patients who are fit enough for the extensive, potentially morbid procedures necessary, whose tumors are amenable to resection with negative margins, and who have been counseled regarding the impact of re-resection on postoperative function and quality of life.