Introduction: Recurrent disease following colorectal cancer surgery will occur in about 30-50% of patients when considering both locoregional relapse and distant metastasis. For patients with rectal cancer, preoperative chemoradiotherapy followed by TME can provide durable 10-years overall survival (OS) of 58% and recurrence-free survival (RFS) of 62%.

Background: Despite optimal treatment with neoadjuvant therapy and a complete TME, some rectal cancers still recur locally. Over the last two decades, the rates of local recurrence have been reduced.

Patients and Methods: To identify the optimal treatment strategy patients can be divided into four clinical groups: resectable disease, potentially resectable, non-resectable with or without intensive treatment.

Results: In the case of a resectable disease, the option of upfront surgical intervention was offered to a selected subset of patients with a local recurrence. In the case of a potentially resectable disease with curative intention, there is no consensus about neoadjuvant therapy for recurrence. Options are chemotherapy, external beam radiotherapy (EBRT), brachytherapy or intraoperative radiotherapy (IORT). In non-resectable disease category with a disseminated disease, when it is necessary intensive treatment, the cytotoxic doublet in combination with a monoclonal antibody is the preferred option. In the non-resectable disease category with a disseminated disease when the patients have no cancer-related symptoms, the cytotoxic doublet or mono-chemotherapy with or without biological target agent is the preferred option.

Discussion and Conclusions: Surgical resection with microscopically negative margins is the only curative procedure for rectal cancer recurrence. Preoperative RT in association with chemotherapy offers significantly better survival compared with surgery alone. An accurate multidisciplinary approach to patients with recurrence of colorectal cancer should be performed in order to avoid unnecessary laparotomies and guarantee the best-tailored chance of cure to the individual patient.