Do you offer adjuvant chemotherapy to patients with rectal cancer who were on Watch-and-Wait, had local recurrence and underwent resection?

I would not. Watch and wait indicates the patient already received some form of chemotherapy and I do not know that additional chemo after removing a regrowth of the tumor will make much or any difference.

It might depend on the length of time since the systemic therapy was given. If initially node negative and turns out to have nodal disease with a local recurrence, I would be inclined to check Signatera assay after resection and consider systemic therapy if positive.