Local tumor recurrence rates after curative rectal cancer surgery are
reportedly high and herald a poor diagnosis. Extramural recurrence is
most common and is due to the failure to remove all of the tumor durin
g the initial operation. In the rarer anastomotic recurrence, the impl
antation of exfoliated malignant cells is possible, but histochemical
changes in the mucosa surrounding a tumor may be considered as an alte
rnative cause of local recurrence. Local recurrence rates did not impr
ove when the distal margins were extended over 2 cm, but microscopic l
ateral tumor extension appears to be the major determinant of recurren
ce. Early diagnosis is based on frequent CEA assays, history, physical
examination, endoscopy, endoluminal ultrasound and pelvic CT scan. Ag
gressive treatment involving a combination of field irradiation, surgi
cal debulking and intra-operative radiation can result in local contro
l and long-term survival in 10 to 25 % of patients.