Local recurrence has been shown to be a high-risk factor for survival.
However, the report of clear margins on frozen section does not guarantee that
local recurrence will not occur nor does the report of positive frozen section imply that recurrence is imminent.
Analysis of data found a higher
local recurrence rate with narrow surgical margins (< 2mm margins) at 31% compared with the adequately excised group (≥ 2mm margins) at 11%.
Preoperative radiotherapy was gradually introduced in the early 1990s, with a consequent improvement in prognosis for people with rectal cancer and reduction in the risk of
local recurrence.
No recurrence was detected in 16(80%) of the patients during follow up, while recurrence after six months was detected in four (20%) cases (ipsilateral neck recurrence in two, and
local recurrence in other two cases).
In 90% of cases, the
local recurrence has been reported after curettage and bone grafting.
We found that sentinel lymph node biopsy in our clinic had a 91% negative predictive value for
local recurrence, nodal recurrence, and disease-specific death.
Pathological analysis confirmed
local recurrence with adenocarcinoma Gleason score 7 (3 + 4) in 10% of two of six core biopsies.
It was first described in 1910 by MacCormac and later by various authors which has a potential for aggressive infiltration,
local recurrence and distant metastatic spread.
After six months follow-up, there were no signs of
local recurrence.
The surgical approach should be extensile in nature to permit possible future resections for
local recurrence or revisions.
In the control arm, those who had been directly taken up for surgery without neoadjuvant chemotherapy, one patient with stage III disease and four patients with stage IVA disease had
local recurrence.
