Significance of local recurrence of rectal cancer as a local or disseminated disease

Background The nature of ‘local recurrence’ of rectal cancer remains unclear. Methods Fifty‐nine patients with locally recurrent rectal cancer who underwent extended repeat resections including total pelvic exenteration (39) and sacrectomy (43) were reviewed. Twelve patients had distant metastases before or at the time of repeat resection. Results The 5‐year survival rate was 25 per cent. A second recurrence occurred in 45 patients including five of the eight 5‐year survivors. Thirty‐six of these recurrences had locoregional manifestations and 29 had distant metastases. Of 18 prognostic factors examined, the most significant determinant was the postoperative carcinoembryonic antigen doubling time (CEADT), followed by the preoperative CEADT, carcinoembryonic antigen (CEA) level and occurrence of distant metastases, in decreasing order. Late onset of first recurrence was also a favourable indicator. Thus, the growth rate of the tumour had a more profound impact on survival than the current extent of tumour progression. After operation the CEADT was reduced in patients with second recurrence ( P = 0·05). Conclusion Locally recurrent rectal cancer is a manifestation of disseminated disease spreading locoregionally and often to distant organs with a low probability of long‐term cure. However, survival varies widely depending on the tumour growth rate, which is biologically predetermined and is also influenced by surgery. © 1998 British Journal of Surgery Society Ltd