Abstract
Developments in chemotherapeutic strategies and surgical technique have led to improved loco regional control of rectal cancer and a decrease in recurrence rates over time. However, locally recurrent rectal cancer continues to present considerable technical challenges and results in significant morbidity and mortality. Surgery remains the only therapy with curative potential. Despite a hostile intra-operative environment, with meticulous pre-operative planning and judicious patient selection, safe surgery is feasible. The potential benefit of new techniques such as intra-operative radiotherapy and high intensity focussed ultrasonography has yet to be thoroughly investigated. The future lies in identification of predictors of recurrence, development of schematic clinical algorithms to allow standardised surgical technique and further research into genotyping platforms to allow individualisation of therapy. This review highlights important aspects of pre-operative planning, intra-operative tips and future strategies, focussing on a multimodal multidisciplinary approach.
Highlights
Local recurrence of rectal cancer is difficult to treat, may cause severe disabling symptoms, and often holds a dismal prognosis
Since 20% to 50% of these patients has local recurrence in the absence of distant metastasis, it is intuitive that surgical management represents a viable treatment option [2]
Surgical management of local recurrence of colorectal cancer has not attained the international approval which has been bestowed upon resection of distant metastases such as hepatic disease
Summary
Local recurrence of rectal cancer is difficult to treat, may cause severe disabling symptoms, and often holds a dismal prognosis. Surgery for locally recurrent rectal cancer, requires the undertaking of complex techniques in a hostile operative environment and in many cases requires input from other specialities such as urology, gynaecology and vascular teams. These surgeries should in principle only be performed in a tertiary centre with appropriate surgical, anaesthesiology, and intensive care expertise. Surgical management of local recurrence of colorectal cancer has not attained the international approval which has been bestowed upon resection of distant metastases such as hepatic disease. This paper highlights pertinent issues regarding surgical preparation and techniques with a focus on the importance of a multimodal approach
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