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World J Gastroenterol. Jun 21, 2017; 23(23): 4170-4180
Published online Jun 21, 2017. doi: 10.3748/wjg.v23.i23.4170
Advances in surgical management for locally recurrent rectal cancer: How far have we come?
Daniel Jin-Keat Lee, Peter M Sagar, Gaitri Sadadcharam, Kok-Yang Tan
Daniel Jin-Keat Lee, Gaitri Sadadcharam, Kok-Yang Tan, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Peter M Sagar, John Goligher Colorectal Surgery Unit, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom
Author contributions: Lee DJK performed the majority of the research around this topic, wrote the manuscript and obtained figures for the article; Sagar PM and Tan KY designed the article framework and contributed to the editing of the manuscript; Sadadcharam G contributed to the editing of the article as well as some of the writing.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kok-Yang Tan, Associate Professor, Head and Senior Consultant, Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. tan.kok.yang@alexandrahealth.com.sg
Telephone: +65-6602-2207 Fax: +65-6602-3648
Received: January 27, 2017
Peer-review started: February 4, 2017
First decision: February 23, 2017
Revised: March 31, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: June 21, 2017
Abstract

Locally recurrent rectal cancer (LRRC) is a complex disease with far-reaching implications for the patient. Until recently, research was limited regarding surgical techniques that can increase the ability to perform an en bloc resection with negative margins. This has changed in recent years and therefore outcomes for these patients have improved. Novel radical techniques and adjuncts allow for more radical resections thereby improving the chance of negative resection margins and outcomes. In the past contraindications to surgery included anterior involvement of the pubic bone, sacral invasions above the level of S2/S3 and lateral pelvic wall involvement. However, current data suggests that previously unresectable cases may now be feasible with novel techniques, surgical approaches and reconstructive surgery. The publications to date have only reported small patient pools with the research conducted by highly specialised units. Moreover, the short and long-term oncological outcomes are currently under review. Therefore although surgical options for LRRC have expanded significantly, one should balance the treatment choices available against the morbidity associated with the procedure and select the right patient for it.

Keywords: Recurrent rectal cancer, Sacrectomy, Pelvic exenteration, Pelvic sidewall, Radical resection

Core tip: This article provides an up-to-date review of the current international trends in surgical approaches for locally recurrent rectal cancer (LRRC), specifically highlighting the novel radical techniques that are now used in cases previously deemed unresectable. We have described these approaches according to anatomical locations of the recurrences and reviewed the respective oncological and functional outcomes. In addition, laparoscopic surgeries for LRRC are discussed and their outcomes are outlined.