Abstract Aim Patients with locally recurrent rectal cancer (LRRC) frequently present with either synchronous metastases or a history of metastases. This study was conducted to evaluate whether LRRC patients without metastases have a different oncological outcome compared to patients with a history of metastases treatedwith curative intent or patients with potentially curable synchronous metastases. Method All consecutive LRRC patients who underwent intentionally curative surgery between 2005 and 2017 in a large tertiary hospital were retrospectively reviewed and categorized as having no metastases, a history of (curatively treated) metastases or synchronous metastases. Patients with unresectable distant metastases were excluded from the analysis. Results Of the 349 patients who were analysed, 261 (75 percent) had no metastases, 42 (12 percent) had a history of metastases and 46 (13 percent) had synchronous metastases. The 3-yearmetastasis-free survival was 52percent, 33percent and 13percent inpatients without metastases, with a history of metastases, and with synchronous metastases, respectively (P < 0.001) A history of metastases did not influence overall survival (OS), but there was a trend towards a worse OS in patients with synchronous metastases comparedwith patients without synchronousmetastases (hazard ratio 1.43; 95 percent CI 0.98-2.11). Conclusion LRRC patients with a history of curatively treated metastases have an OS comparable to that in patients without metastases and should therefore be treated with curative intent. However, LRRC patients with synchronous metastases have a poor metastasisfree survival and worse OS; in these patients, an individualized treatment approach to observe the behaviour of the disease is recommended.
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