Over the last decades the
therapy of rectal
carcinoma has shown continuous improvement. Due to improvements in operative techniques, such as the establishment of total mesorectal excision (TME) and the combination of surgery and (neo-)
adjuvant radiochemotherapy, the incidence of locally recurrent
rectal cancer could be improved from nearly 50% to less then 10%. Nevertheless recurrent rectal
carcinoma remains a severe problem. Predictive factors relating to locally recurrent
rectal cancer are surgical experience, localization of the
tumor, circumferential
resection margins, stage-oriented multimodal
therapy and a suitable oncological procedure for the primary
tumor. In addition the
tumor-specific biology also seems to be a relevant risk factor for recurrence. Operative treatment of locally recurrent
rectal cancer was seen for a long time as a palliative procedure. Newer data show that resection of locally recurrent
rectal cancer can be carried out with a curative intention in experienced institutions with a long-term 5 year survival of about 30% and mortality around 5%. The composite sacropelvic resection technique is a reasonable option in the curative treatment of locally recurrent
rectal cancer. For the future the focus must be on improvements in the primary
therapy of rectal
carcinoma to avoid local recurrence. In addition early diagnosis of local recurrence and multimodal
therapies will be of decisive importance.