LOCAL RECURRENCE OF COLORECTAL-CANCER - THE PROBLEM, MECHANISMS, MANAGEMENT AND ADJUVANT THERAPY

Local recurrence of colorectal cancer after 'curative' surgery is a ma jor clinical problem. Typically, 50-70 per cent of patients presenting to a surgical clinic will undergo apparently curative surgery for dis ease and of these about 10-25 per cent will develop local recurrence, in either the tumour bed or bowel wall. The wide differences in local recurrence rate both between and within institutions is probably cause d by variation in surgical technique. The main causes of local recurre nce are inadequate excision of the primary tumour or the draining lymp h nodes, and intraoperative tumour cell implantation. The most signifi cant single factor prognostic of local recurrence is Dukes' tumour sta ge. Other important factors include tumour grade and fixity, level of the tumour in the rectum, blood and lymphatic vessel invasion, inadver tent perforation of the tumour during resection, and the surgeon's exp erience. The prognosis of patients with local recurrence is poor. Prev ention of recurrence by adequate surgery and adjuvant therapy as well as its early detection offer the best prospect of improving results.