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abdominoperineal resection), or local recurrence after transanal or transsphincteric excision. Anterior recurrences involve the urogenital structures while posterior recurrences involve the sacrum and/or coccyx. Lateral recurrences involve the pel­vic sidewall bones, musculature, or sidewall structures [15]. In studies that have used the Memorial Sloan Kettering system to evaluate surgical outcomes, R0 resec­tions were more common for axial recurrences compared all other compartments [15–17]. Iliac vessel involvement was also specically associated with decreased R0 resections rates [15]. Yamada etal. proposed a system based on the pattern of pelvic invasion– localized type, sacral invasive type, and lateral invasive type [18]. Like the Memorial Sloan Kettering system axial compartment recurrence type, sur­vival was best with the local invasive type [18–20]. The Mayo Clinic system uses sites of xation [from 0 sites of xation (F0) to 3–4 sites of xation (F3)] and symp­toms [no symptoms or pain (S0) to symptomatic and painful (S2)] to classify recur­rence [21]. Survival has been shown to decrease with both increasing sites of xation and increasing symptoms and pain [8, 21–23]. Additional classication systems exist and are largely based on the pattern of pelvic invasion [23, 24]. The common theme amongst all recurrence classication systems is that axial or local recurrences and therefore less points of xation are associated with either improved rates of R0 resection, survival, or both. No comparisons between the classication systems exist to determine whether one is more prognostic than others.