Management of locally recurrent rectal cancer

The diagnosis and management of recurrent rectal cancer is surgically and oncologically challenging. Recurrence usually presents within 1–3 years of treatment for primary tumor, and diagnostic workup should assess pelvic resectability and workup for metastatic disease. Treatment includes neoadjuvant chemotherapy and/or radiotherapy, as well as surgical resection when an R0 resection is feasible. Neoadjuvant chemotherapy and radiotherapy is recommended in chemo/radiotherapy naive patients. Preoperative or intraoperative reirradiation is feasible, but the long term impact on likelihood of R0 resection and survivability is controversial. Chemoradiation may also be used to palliate unresectable disease.