[Importance of a loco-regional follow-up after curative operation in cancer of the rectum or sigmoid].

After curative surgery for rectal or sigmoid cancer, loco-regional recurrence occurs in about 30% of the patients. Among them, one third presents no other tumor localization and a new curative surgical excision may, therefore be considered. A review of the literature shows that in these repeated procedures, the only good results, carcinologically, are observed when the original procedure consisted in a recto-colic anastomosis. Re-operations after abdomino-perineal resections have, until now, resulted in carcinologic failures. The location of the pelvic recurrence, after procedures which preserve the anal sphincter function, may be at the level of the anastomosis or most of the time around the anastomosis. If endoscopy is an easy mean of surveillance of the anastomosis, the screening of peri-anastomotic recurrences presents more of a problem. It seems necessary to use, in addition to rectal examination, other techniques which are more easily reproduced and compared with each other in the long run. This could be the case for endo-rectal sonography and pelvic tomodensitometry. As for re-operation itself, it consists essentially in an abdomino-perineal resection possibly associated with radiotherapy.