Local recurrence after anterior resection.

Local recurrence after anterior resection is due to both pathological and surgical factors. The pathological factors include level of tumour, pathological stage, histological grade and the occurrence of perforation. Particularly important is the extent of local spread, which can be identified clinically by digital palpation and by endoluminal ultrasound. Extensive local spread identified preoperatively is related to local recurrence after surgical treatment. Surgical reports of the incidence of local recurrence from less than 5-30%. There is strong evidence of a surgeon-related variable. Mesorectal excision may be associated with a low rate of local recurrence. Pathological involvement of the lateral margin of excision is related to local recurrence. Implantation by viable tumour cells is likely to be related to anastomotic recurrence.