Colorectal cancer: surgical management of recurrent and metastatic disease.

The surgeon's responsibility to patients with colorectal cancer does not end with resection of the primary locoregional disease. The surgeon has a role to play in (1) designing and implementing strategies aimed at preventing recurrence, (2) early detection of recurrent disease, and (3) resective therapy of recurrent disease in selected instances, either with curative intent or for palliation. To perform these roles, the surgeon must have a thorough knowledge of catheter techniques for regional drug delivery, resective techniques for metastatic or locally recurrent disease, and combined surgical and radiotherapy approaches.