Mortality and Morbidity

Historically, morbidity and mortality rates related to surgery for locally recurrent rectal cancer (LRRC) have been >70% and 30%, respectively [1\u20133]. Because of the excessive operative risks, the benefit of such resections has been questioned and \u2014 although radical operation for LRRC was conceptualized and reported more than 60 years ago \u2014 for years it has not been accepted as being standard procedure. More appropriate selection of candidates for resection due to advances in imaging modalities, improvement in surgical techniques, establishment of specialized multidisciplinary surgical teams, and improvement in quality of perioperative management have resulted in better outcomes in recent years. Currently, mortality rates vary between 0\u20135% at 1 month and 8% at 3 months [4]. The causes of death are mainly disseminated coagulopathies related to prolonged sepsis and blood loss, multiorgan failure, cardiac events, and pulmonary embolism [5, 6]. Morbidity remains significant, ranging from 15 to 68%, and increases with the complexity of resection [7\u201310]. Bleeding is the main and most severe intraoperative complication, and occurs in 0.2\u20139% of cases, and related mortality is high (4%) [11\u201314]. The principal postoperative complications include pelvic abscess (7\u201350%), intestinal obstruction (5\u201310%), enterocutaneous or enteroperineal fistulas (1.2%), perineal wound dehiscence (4\u201324%), and cardiovascular, renal, and pulmonary complications (1\u201320%) [5, 7, 8]