To appraise the reported perioperative strategies and oncological outcomes of patients undergoing curative-intent treatment for re-recurrent rectal cancer (RRRC).
Approach:
Eligibility Criteria: Included studies reporting perioperative management and outcomes of adult patients undergoing curative-intent treatment for RRRC.
Information Sources: Conducted according to PRISMA guidelines and registered in PROSPERO. Databases searched included MEDLINE, Cochrane Library, Web of Science, and Scopus.
Risk of Bias Assessment: Methodological quality was assessed using the Newcastle–Ottawa Scale for cohort studies.
Synthesis of Results: Results were synthesized narratively due to heterogeneity in treatment strategies and outcome reporting.
Key Findings:
Three retrospective cohort studies comprising 169 patients were included.
Neoadjuvant therapy was administered in 20–92% of patients, depending on previous radiation dose.
Pelvic exenteration was frequently required, with total exenteration in 6–20% and sacrectomy in up to 15% of cases.
Intraoperative radiotherapy (IORT) was used in 44–77% of patients where available.
R0 resection rates ranged from 33% to 62%, with margin status directly associated with oncological outcomes.
Interpretation:
Curative-intent surgery for RRRC is feasible in highly selected patients, with R0 resection being the principal prognostic determinant of oncological outcome.
Limitations:
Evidence limited to retrospective observational studies with small sample sizes.
Heterogeneous management and varied institutional resources precluded meta-analysis.
Conclusion:
The review highlights the need for further research in the management of RRRC.
