Salvage Surgery for Locoregional Recurrence Following Local Excision

Recurrence following local excision of early rectal cancer has traditionally been considered innocuous and readily amenable to salvage resection, with little impact on overall survival. Recent studies have reported that this notion is incorrect, however. Unlike the primary rectal lesion confined to the intestinal wall, locoregional recurrence following local excision is generally advanced when detected. Salvage surgery often requires extended resections, and in some cases total pelvic exenteration with significant morbidity. Even when salvage surgery is successful at eradicating disease, local control and cure are not assured. It is apparent that the relatively high recurrence rates noted following local excision cannot be compensated for by simple salvage surgery at time of relapse. Improvements in patient selection and identification of micrometastatic disease are necessary to properly select patients for curative local excision, and to avoid locoregional relapse altogether.