title: Clinical review: surgical management of locally advanced and recurrent colorectal cancer.
abstract: OBJECTIVE
  Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.
  
  
  METHODS
  A literature review was performed on the electronic databases MEDLINE from PubMed, EMBASE and the Cochrane library for publications in the English language from January 1993 to July 2013. The MeSH search terms 'locally advanced colorectal cancer', 'recurrent colorectal cancer' and 'surgical management' were used.
  
  
  RESULTS
  A total of 1,470 patients with recurrent or locally advanced primary colorectal cancer were included in 22 studies. Surgical removal of the tumour with negative margins (R0) offers the best prognosis in term of survival with a 5-year survival of up to 70 %. MVR is needed in approximately 10 % with the most commonly involved organ being the bladder. The mean post-operative morbidity is 40 %, mainly relating to superficial surgical site infection, pelvic collections and delayed wound healing. Most patients will undergo radiotherapy and/or chemotherapy pre- or post-operatively. The mean 5-year overall survival for R0 resection is 50 % for recurrent and locally advanced primary tumours while survival following R1 or R2 is 12 and <5 %, respectively.
  
  
  CONCLUSIONS
  Multimodal therapy and extended surgery to achieve clear margins offers good prognosis to patients with recurrent and locally advanced colorectal cancers.
authors.affiliation: Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Republic of Ireland, nichurnd@tcd.ie.
authors.forename: D
authors.initials: D
authors.lastname: Courtney
authors.forename: F
authors.initials: F
authors.lastname: McDermott
authors.forename: A
authors.initials: A
authors.lastname: Heeney
authors.forename: D C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D010385:Pelvic Exenteration; D010533:Peritoneal Lavage; D011183:Postoperative Complications / Q000401:mortality; D012447:Sacrum / Q000473:pathology / Q000601:surgery; D014566:Urogenital System / Q000473:pathology