Past
Despite advances in diagnosis and treatment, locally recurrent rectal cancer (LRRC) remains a complex disease associated with poor oncological outcomes. Over the past two decades, important developments in high-resolution imaging, neoadjuvant treatment, perioperative care, and the centralization of care have transformed the management of LRRC. However, it has remained unclear whether these incremental advances have translated into measurable improvements in outcomes for patients undergoing curative-intent treatment. Accordingly, this study aimed to evaluate long-term trends in the management and oncological outcomes for patients with LRRC treated in a Dutch tertiary referral centre.
Present
Our study included 560 patients who underwent curative-intent resection for a first LRRC between 2000 and 2023.1 Despite an increasingly complex case mix, with more patients presenting with comorbidities, multifocal disease, and synchronous metastases, oncological outcomes improved over time.1 The R0 resection rate increased from 59% to 78%, while cumulative sum analyses demonstrated progressive improvements in both overall and disease-free survival.1 Overall, outcomes for patients undergoing curative-intent treatment for LRRC have steadily improved over the past two decades. This may reflect advances in diagnostics, neoadjuvant therapy, surgical technique and perioperative care, centralization of care, and patient selection.
Future
Although oncological outcomes after curative-intent treatment have improved substantially, a substantial group of patients with LRRC remain ineligible for curative-intent treatment.2–4 Further progress will depend not only on advances in multimodal therapy, but also on improving patient selection. Integrating advanced imaging with clinical and biological markers may better distinguish favourable from aggressive tumour biology, enabling more informed selection of patients for neoadjuvant treatment and surgery. Ongoing prospective studies, including PelvEx II,5 will clarify the role of induction chemotherapy and help determine which patients derive the greatest benefit from intensified multimodal treatment.
Acknowledgement
None.
Funding
This research received no specific grant or funding from any public, commercial or not-for-profit institution. Research grants for complex colorectal cancer were awarded to Catharina Hospital Eindhoven in name of Dr. J.W.A Burger by ZonMW (1007001201003) and the Dutch Cancer Society (2020-1/12960).
Disclosure
All the aforementioned authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Ethical Approval
This study was reviewed and approved by the Medical Research Ethics Committees United – Nieuwegein (registration number AW23.041W23.008). The study was not subject to the Medical Research Involving Human Subjects Act. Written informed consent for participation was waived due to the retrospective nature of this study.
Footnotes
This article refers to: Vande Kerckhove FEC, Creemers DMJ, Banken E, et al. Evolution of prognosis and management in curative treatment of locally recurrent rectal cancer: a comprehensive analysis from 2000 to 2023. Ann Surg Oncol. 2026.(https://doi.org/10.1245/s10434-026-20398-6).
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
F. E. C. Vande Kerckhove and D. M. J. Creemers have equally contributed to this work.
References
- 1.VandeKerckhove FEC, Creemers DMJ, Banken E, et al. Evolution of prognosis and management in curative treatment of locally recurrent rectal cancer: a comprehensive analysis from 2000 to 2023. Ann Surg Oncol. 2026. 10.1245/s10434-026-20398-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Swartjes H, van Rees JM, van Erning FN, Verheij M, Verhoef C, de Wilt JHW, et al. Locally recurrent rectal cancer: toward a second chance at cure? A population-based, retrospective cohort study. Ann Surg Oncol. 2023;30(7):3915–24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Westberg K, Palmer G, Hjern F, Nordenvall C, Johansson H, Holm T, Martling A. Population-based study of factors predicting treatment intention in patients with locally recurrent rectal cancer. Br J Surg. 2017;104(13):1866–73. [DOI] [PubMed] [Google Scholar]
- 4.van der Meij W, Rombouts AJ, Rutten H, Bremers AJ, de Wilt JH. Treatment of locally recurrent rectal carcinoma in previously (chemo)irradiated patients: a review. Dis Colon Rectum. 2016;59(2):148–56. [DOI] [PubMed] [Google Scholar]
- 5.PelvEx C. Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II). BJS Open. 2021;5(3). [DOI] [PMC free article] [PubMed]