In patients with locally recurrent rectal cancer (LRRC), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) not only can predict 5-yr overall survival (OS) but can also identify a subset of R+ cases with a similar expected survival than R0 cases.

• This study included 184 LRRC patients treated at the National Cancer Institute of Milan (Italy).

• Worse OS was observed in relation to NLR >3.9 (hazard ratio [HR] 3.96), PLR >275 (HR 5.39) and size on imaging (HR 1.36).

• A significantly lower 5-yr OS was experienced by R+ patients with NLR >3.9 vs NLR ≤3.9 (13.5% vs 36.7%).

• A lower 5-yr OS was observed in association with PLR >275 vs PLR ≤275 in R+ patients (6.4% vs 36.8%).

• Conversely, NLR and PLR were identified to be irrelevant in case of R0 surgery.