title: Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow-up detects some late local and systemic recurrences.
abstract: BACKGROUND
  The necessity, timing and benefits of follow-up after rectal cancer surgery remain controversial, with two years traditionally considered adequate to detect most local recurrences. This unit has a policy of lifetime follow-up, and this paper investigates, at 23 years, the value of prolonged surveillance.
  
  
  METHODS
  Six hundred and sixty consecutive patients undergoing surgery for rectal cancer were prospectively followed-up between 1978 and 2002, and local or systemic recurrence recorded. This analysis was performed on the 509/660 (76%) patients who underwent potentially curative surgery.
  
  
  RESULTS
  Total mesorectal excision (TME) was performed in 422/509 (83%) patients, mesorectal transection in 78 (15%), and local excision in 9 (2%). Follow-up ranged from 1 to 23 years (mean = 9.7). Seven (1.4%) patients had local recurrence alone, 11 (2.2%) local plus systemic, and 86 (17%) systemic recurrence alone. Of the local recurrences 3 (17%) became evident within 1 year, 9 (50%) within 2 years, 16 (89%) within 5 years, and 2 (11%) presented after 5 years, at 5.6 and 5.8 years. Of the systemic recurrences 26 (27%) became evident within 1 year, 57 (59%) within 2 years, 93 (96%) within 5 years, and 4 (4%) presented after 5 years at 5.3, 5.3, 5.4 and 7.9 years.
  
  
  CONCLUSIONS
  This long-term surveillance of patients undergoing curative surgery for rectal cancer demonstrates that most local and systemic recurrences occur within 5 years. Almost half occurred more than 2 years after surgery. However, those centres wishing to set standards of care, or evaluate current or new therapies in rectal cancer treatment, should be aware that unexpected late recurrences occasionally develop.
authors.affiliation: Colorectal Research Unit, North Hampshire Hospital, Basingstoke, UK.
authors.forename: E
authors.initials: E
authors.lastname: Moore
authors.forename: R J
authors.initials: RJ
authors.lastname: Heald
authors.forename: T D
authors.initials: TD
authors.lastname: Cecil
authors.forename: G D
authors.initials: GD
authors.lastname: Sharpe
authors.forename: R
authors.initials: R
authors.lastname: Sexton
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors