Fifty-five patients had resection of locally recurrent rectal cancer.
Fourteen patients (25 per cent) had distant metastases, which were res
ected concurrently in six (11 per cent). Thirty-three patients (60 per
cent) had preoperative (one patient) or postoperative (32) external b
eam radiotherapy (45-60 Gy). The 5-year survival rate was 18 per cent
with a median survival of 24 months. The median symptom-free interval
was 24 months. At a median follow-up of 28 months 53 per cent of patie
nts had a second local recurrence and 24 per cent metastases only. Tre
atment complications occurred in 12 patients (22 per cent), three (5 p
er cent) of whom died 3-10 months after operation. Variables that were
significantly related with longer survival and palliation were the ra
dical nature of the operation, the absence of severe symptoms (such as
pain, obstruction or sepsis), a recurrent tumour diameter of less tha
n 5 cm measured on the resected specimen and a normal carcinoembryonic
antigen level after reoperation. A Cox regression model showed that r
ecurrent tumour diameter was the only independent prognostic variable,
Surgery for local recurrence achieved local control in 47 per cent of
patients with a low morbidity and mortality rate.