Oncological Outcomes of Locally Recurrent Rectal Cancer Treated With Curative Intent: A Single Center Retrospective Cohort Study

Background: Treatment paradigms for patients with locally recurrent rectal cancer (LRRC) have shifted from palliative approaches to multimodal curative-intent treatment in selected patients. This retrospective cohort study evaluates survival outcomes following curative-intent treatment in patients with LRRC. Methods: All consecutive patients with LRRC undergoing curative-intent treatment at a tertiary referral center between 2014 and 2024 were retrospectively analyzed (n = 147). Overall survival (OS), local re-recurrence-free survival (LRFS), metastasis-free survival (MFS), and prognostic factors were analyzed using Kaplan–Meier and Cox regression analyses. Results: 147 patients underwent neoadjuvant treatment with curative intent at baseline. After response assessment, 117/147 (80%) patients continued curative therapy, which consisted of 109/117 (93%) patients undergoing surgery and a highly selected group of 8/117 (7%) patients monitored with a watch-and-wait strategy. For the remaining 30/147 patients (20%), treatment intent changed from curative to palliative. Median OS was 54 months with a 5-year OS of 47%. For patients treated with an overall curative intent (n = 117), median OS was 63 months with a 5-year OS of 58%. Clear resection margins, achieved in 76% of surgical cases, was a prognostic factor for OS and LRFS: 5-year OS was 66% for R0-resections and 33% for R1-resections (p < 0.001), and 3-year RFS was 69% for R0-resections and 50% for R1-resections (p < 0.001). Among the watch-and-wait group, 5/8 patients remained alive and disease-free (median follow-up 14 months (IQR 9–16)). Conclusions: This single-center retrospective cohort study demonstrates reasonably good oncological outcomes following curative-intent LRRC treatment. Further investigation of watch-and-wait strategies in highly selected patients is warranted.