Background: The literature on resection of locally recurrent rectal cancer (LRRC) consists largely of case series based on retrospective data collection with median follow-up of less than 36 months. The goal of the present study was to determine outcomes after 5 to 10 yrs of follow-up in a group of patients managed with a consistent approach. Methods: We identified patients who underwent resection of LRRC between 06/1997 and 05/2005 from the prospective colorectal cancer databases in two cancer centers at the University of Toronto, Canada. Median follow-up time for the entire cohort (n=52) was 44 months; median follow-up in surviving patients (n=25) was 91 months. Results: All 52 patients (median age=60, 31 male) underwent grossly complete resection of their locoregional recurrence; 6 had synchronous distant metastases at the time of LRRC resection. The most common operative procedure for LRRC was a pelvic exenteration with sacrectomy (n=22). 24 patients had received adjuvant XRT for their primary tumor and 26 radionaïve patients received XRT prior to resection for recurrence. At last follow-up, 16 patients were alive with no evidence of disease; 9 alive with disease; 26 had died of disease; and 1 died of other causes. For the entire cohort (n=52), 5-yr and 8-yr Overall Survival (OS) were 49% and 46%, respectively; median OS was 60 months. M1 disease at the time of LRRC resection was associated with inferior OS (p=0.04). Predictors of improved OS included node negative primary cancer (p=0.02); receipt of systemic chemotherapy prior to LRRC resection (p=0.02); and R0 margin of resection on LRRC (p<0.0001). Sacrectomy (n=30) was not a prognostic factor. In patients with no distant metastases at the time of LRRC resection (M0, n=46), 5-yr and 8-yr re-recurrence-free survival were 35% and 31%, respectively. Patients who were clinically M0 at time of LRRC resection in whom R0 resection was achieved (n=36) had 5-yr and 8-yr OS of 65% and 61%, respectively; in that group, re-recurrence-free survival at 5 and 8 yrs were 45% and 39%, respectively. Conclusions: Margin negative resection of LRRC can result in extended survival beyond 5 yrs. Use of preoperative systemic chemotherapy and sacrectomy may be associated with improved results.