Identifying molecular biomarkers could enhance patient selection for salvage surgery in locally recurrent rectal cancer, impacting surgical strategies and patient outcomes.

• Locoregional recurrence rates after surgery ranged from 15% to 52% over 3-5 years.
• Five-year overall survival rates varied from 22% to 53%.

Surgeons should consider serum biomarkers like CEA and CA19-9, linked to poor survival, for patient risk assessment.

• Elevated CEA was associated with shorter overall survival in 11 studies.
• Contemporary biomarkers remain unstudied in this population, indicating a research gap.