Background: It has not been common practice to operate local recurrence after rectal cancer and the treatment has received little attention in the J Norw Medical Ass.
Material and methods: This overview is based on literature retrieved from PubMed and own experience during 16 years.
Results and interpretations: Type of local recurrence and the treatment related to it are classified and described. Most recurrences will benefit from preoperative irradiation. The difficulties caused by the confusion of postoperative fibrosis and recurrent cancer with regard to diagnosis, operability, the demand for multivisceral resection and the operative technique are discussed. The operations will often require cooperation between rectal surgeons, urologists, orthopaedists as well as plastic surgeons and gynaecologists. Our hospital has one of the largest published series, most other materials are small (< 70 patients). The results vary considerably regarding both survival and re-recurrences. This may be caused by differences in patient selection, oncological treatment and surgical aggressiveness. The surgical radicality is the most important prognostic factor. After a microscopic radical resection (R0 resection) the survival is similar to that for resection of Dukes C-grade primary colorectal cancer. The prognosis can probably be improved by improving the preoperative chemoradiation. This treatment should only be offered in a few centres in Norway because of the specific requirements.