Overall recurrence following curative resection for colorectal cancer has been variably reported to be between 25% to 50%. Lungs, liver, and locoregional sites are most frequently involved, but although isolated hepatic and pulmonary metastases have been aggressively targeted, pelvic recurrences have been traditionally considered unsalvageable. Loco-regional recurrence is noted in up to 19%sd of colonic and 33% of rectal cancers, and may be frequently encountered in general surgical practice. In view of the technically demanding nature of surgical resection, and the prospect of major morbidity, it is not uncommon to withold aggressive intervention and follow a palliative line of management notwithstanding the dismal survival outcome. The aim of this article is to highlight the diagnostic and therapeutic strategies for locally recurrent colorectal cancer which can be of significant survival or palliative value in a select group of patients.