• Assessment
• Education
• Training

The introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery.

To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.

We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced.

Overall, 214 patients were included. In terms of operative time, CPA identified the 110^th case as the first turning point. A plateau was reached after the 145^th case. Subgroup analysis estimated the 58^th for colon and 52^nd case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints.

The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.

• Colorectal
• Education
• Gastrointestinal
• Laparoscopy
• Outcomes

To summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC).

LRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction. However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life.

We searched English-language articles with keywords “locally recurrent rectal cancer”, “surgery” and “multidisciplinary team” in PubMed published between January 2000 to October 2020.

LRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients’ quality of life.

• Locally recurrent rectal cancer (LRRC)
• multidisciplinary team (MDT)
• surgery

• Cadaver
• Hemodynamics
• Iliac vein
• Pelvic exenteration
• Sacrum

• Deep venous thrombosis
• Pulmonary embolism
• Rectal surgery
• Surgical outcomes
• Venous thromboembolism

• Advanced rectal cancer
• Colorectal surgery
• Complication
• Outcome
• Pelvic exenteration

• Aged
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/prevention & control
• Neoplasm Staging
• Pelvic Exenteration/adverse effects
• Perioperative Period
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prospective Studies
• Quality of Life
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/pathology
• Retrospective Studies
• Risk Assessment
• Treatment Outcome

To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.

A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.

At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.

Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.

• Rectal cancer recurrence
• Local recurrence
• Sacral resection
• Abdominosacral resection
• Recurrent rectal cancer