e15159 Background: Locoregional recurrence of rectal cancer (LRRC) might be occurred even after combination treatments including surgery and pelvic radiotherapy. Re-irradiation might provide the control of recurrence and/or symptomatic palliation, but possible complications are fearful hindrances. This study is to integrate information from various clinical studies, regarding re-irradiation and/or surgery of LRRC, and to provide practical information for clinical decision making. Methods: We searched four databases including pubmed, MEDLINE, Cochrane library, and Embase. The primary endpoint was overall survival (OS), and secondary endpoints were complications of grade ≥3, local control rate (LC), and symptomatic palliation rate. Results: A total of 17 studies, involving 18 cohorts and 744 patients with LRRC were included. Median OS among included studies ranged from 10 to 45 months (median: 24.5 months). Pooled 1-, 2-, and 3- year OS rates for all LRRC patients were 76.1% [95% confidence interval (CI): 61.7-86.3], 49.1% (38.5-59.7), and 38.3% (30.2-47.2), respectively. For patients who underwent re-irradiation and surgery (OP group), pooled 1-, 2-, and 3- year OS rates were 85.9% (95% CI: 74.0-92.9), 71.8% (54.6-84.4), and 51.7% (39.4-63.8). For patients who underwent re-irradiation but not surgery (non-OP group), pooled 1-, 2-, and 3-year OS rates were 63.5% (95% CI: 51.1-74.4), 34.2% (20.4-51.2), and 23.8% (15.4-34.8). The difference between two subgroups were significant for all 3 years analyses. Pooled 1-, 2-, and 3- year LC rates for OP group were 84.4% (95% CI: 75.5-90.4), 63.8% (55.2-71.5), and 46.9% (39.6-54.4), and for non-OP group were 72.0% (95% CI: 48.8-87.4), 54.8% (28.6-78.5), and 44.6% (16.6-76.5). The difference between subgroups were not statistically significant for all 3 years analyses. Pooled overall grade ≥3 acute complication rate was 11.7% (95% CI: 6.7-19.5), and for late complication was 25.5% (95% CI: 16.7-40.0). Patients who underwent surgery had a higher risk of grade ≥3 late complications (OR: 6.39, 95% CI: 3.2-12.7). Pooled symptomatic palliation rate was 75.2% (95% CI: 67.3-81.8). Conclusions: Re-irradiation and/or surgery might be an option with oncologic and palliative efficacies, where combined surgery provided more favorable survival outcome. However, late complication should be carefully considered especially when combined with surgery.