Local recurrence following rectal resection for cancer

Recurrent rectal carcinoma following surgery carries an extremely poor prog nosis and subsequent intervention is usually palliative. The incidence of l ocal recurrence (LR) following curative surgery for rectal cancer has been reported to range from 3.7 to 50%. Current treatment strategy for rectal ca ncer aims at minimizing LR by either pre-operative radiotherapy or adjuvant chemoradiotherapy. Three hundred and fifty-four patients underwent surgica l resection for rectal cancer in our department between April 1989 and Marc h 1994, of which 47 (13%) were Dukes A, 88 (25%) Dukes B, 143 (40%) Dukes C and 76 (22%) Dukes D. Two hundred and seventy-eight (79%) patients were de fined as having had curative resection (Dukes A, B and C). Overall, total L R occurred in 43 (12.2%) of 354 patients, while LR following curative resec tion occurred in 16 (9.4%) of the 278 patients. The incidence of LR became higher with increasing depth of invasion and lymph nodal involvement as sho wn by its direct relationship to stage of disease: Dukes A (0%), B (5.7%), C (14.6%) and D (22.3%). Local recurrence following resection for rectal ca ncer in our series is low. Pre-operative radiotherapy or adjuvant chemoradi otherapy may not further reduce this low incidence of LR significantly and its role needs to be re-evaluated for institutions with low local recurrenc e rates.