Colorectal Cancer: Management of Local Recurrence
Local recurrence after surgery for colorectal cancer remains a challenging clinical problem. Modern imaging has allowed for better patient selection and gives the surgeon a higher degree of certainty about his or her ability to achieve a curative resection. Indications for surgery in patients with local recurrence have expanded to include patients with higher sacral involvement and extensive pelvic sidewall disease. Given the risks associated with increasingly more complex operations, several centers around the world have developed organized multidisciplinary teams of expert surgeons to make operating safer and more efficient. Surgery that achieves a negative-margin resection remains the universal predictor of oncologic outcome in patients with local recurrence. Improved surgical technique and the appropriate use of chemotherapy and radiation have led to increasingly better oncologic outcomes over the past 20 years. Postoperative morbidity remains high in patients with local recurrence and negatively impacts their quality of life. New strategies to mitigate morbidity should be the focus of future research.