Curative surgery for locally recurrent rectal cancer (LRRC) is yielding better long-term outcomes, with a significant increase in the R0 resection rate and overall survival.

• The R0 resection rate increased from 59% to 78% from 2000 to 2023 (p < 0.001).
• Overall survival significantly improved in the recent cohort (2018-2023) with a hazard ratio of 0.75, indicating a 25% reduced risk of death (p = 0.030).

This trend suggests that advancements in treatment methods and patient selection may enhance results for LRRC surgery, making the importance of meticulous surgical planning and perioperative care even more critical.