title: Routine endoscopic surveillance for local recurrence of rectal cancer is futile.
abstract: BACKGROUND
  National Comprehensive Cancer Network guidelines for rectal adenocarcinoma regarding routine surveillance with proctoscopy for local recurrence have been evolving. The purpose of this study was to examine the utility of rectal surveillance.
  
  
  METHODS
  This is a single-center, retrospective review of patients (2004 to 2011) who underwent total mesorectal excision for rectal cancer. The primary end point was cancer recurrence, with detection method(s) noted. The number of surveillance procedures was collected.
  
  
  RESULTS
  The study included 112 patients. There were no local recurrences identified by rectal surveillance. There were 1 local recurrence and 17 distant recurrences (16%). The local recurrence was identified by carcinoembryonic antigen and symptoms. There were 20 anoscopies, 44 proctoscopies, and 495 flexible sigmoidoscopies performed, with estimated charges of $266,000.
  
  
  CONCLUSIONS
  Rectal surveillance at this center was not beneficial. This study supports the recent (2015) change in the National Comprehensive Cancer Network guidelines, which no longer recommend routine rectal surveillance and challenge other society guidelines.
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Luke A
authors.initials: LA
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Gross
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mone
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Whiting
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Hansen
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Mecham
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: William
authors.initials: W
authors.lastname: Peche
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA. Electronic address: courtney.scaife@hci.utah.edu.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Scaife
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012812:Sigmoidoscopy; D014589:Utah
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen
keywords: Local recurrence rectal cancer; Proctoscopy; Rectal cancer; Rectal endoscopy; Rectal surveillance