Surgical treatment of recurrences following sphincter-saving procedures for cancer of the rectum

Of 77 patients treated by sphincter-saving procedures (anterior or pull-through resection) for cancer of the rectum, 17 (22%) developed a local recurrence; 10 of them were submitted to abdominoperineal resection. The 'rescue' operation was technically difficult, and major problems, including large blood loss and urethral complications, were often encountered. At operation the recurrent malignancy was more extended than preoperative diagnosis suggested, and reoperation was not macroscopically radical in one case. All patients but one died from the disease after a mean period of 19.8 months. Causes of local failure are analyzed to interpret the rationale of surgical approach related to the poor results observed; intensive follow-up programs are also discussed. It is concluded that surgical treatment of local recurrence after sphincter-saving procedures must be reserved only for selected patients with limited malignancy, and adjuvant radiochemotherapy should also be employed.