Purpose: After curative rectal cancer surgery, local recurrences manifest in 2.4-10% and distant metastases in 20-50% of patients. The effectiveness of different surveillance regimens is not well established. We evaluated the pattern of recurrence and the utility of different surveillance instruments. Risk factors for recurrence were also recorded.
Methods: This retrospective study comprises 580 consecutive rectal cancer patients operated on at Helsinki University Central Hospital, Finland, during 2005-2011. Data were collected from patient records. After exclusions, 481 patients treated with curative intent remained. Patients were followed up according to an intensive surveillance program.
Results: Rectal cancer recurrence was observed in 124 patients (25.8%). Local recurrence manifested in 40 patients (8.3%) and distant metastases in 112 patients (23.3%). Recurrences were observed a median of 1.3 years after surgery. Twelve patients had to be followed up to find one local recurrence and four patients to find one distant metastasis. Recurrences detected during regular follow-up visits were discovered on average earlier than those detected in additional visits arranged because of patient symptoms (p = 0.023 for local recurrence, p = 0.001 for distant metastases). All surveillance instruments were similarly useful in finding recurrence. Curative treatment was possible in 51 (41.1%) of 124 patients with disease recurrence. Follow-up led to a 10.0% chance of detecting recurrence that could be treated with curative intent.
Conclusions: Rectal cancer recurrences are detected earlier within a surveillance program than by symptoms alone. The most intensive follow-up should be focused on patients with known risk factors for recurrence.