Multimodal treatment of recurrent pelvic colorectal cancer.

The surgical management of locally recurrent rectal cancer is particularly challenging and it should be performed in specialist units characterized by multidisciplinary surgical team, appropriate expertise in anaesthesiology and intensive care and appropriate systems for rehabilitation. Although the mortality rate has been progressively reduced over the years, the complication rate is still not negligible. Patient selection is fundamental to prevent unnecessary morbidity in those whose survival is not likely to be significantly improved. Bleeding is the main intraoperative complication and it can be sudden, severe and life-threatening. Different strategies can be used to cope with massive intraoperative hemorrhage and postoperative complications.