title: Clinical Pattern of Recurrent Disease during the Follow-Up of Rectal Carcinoma.
abstract: OBJECTIVE
  Several initiatives have started to transfer colorectal cancer follow-up (FU) from secondary to primary care. For this purpose, it is important to assess when and how recurrences of rectal carcinoma are detected after treatment with curative intent.
  
  
  METHODS
  Retrospective multicentre cohort study. Patients participating in an FU programme after curative intended treatment for rectal cancer stages I-III between 2007 and 2014.
  
  
  RESULTS
  Of the 378 patients, 64 (17%) developed recurrent disease (RD). Most were detected during scheduled FU consultations (n = 55) by (a combination of) radiological examinations and carcinoembryonic antigen levels, and were asymptomatic (n = 53); outside scheduled FU consultations, RD was detected during the treatment of postoperative complications or ostomy reversal (n = 5), or due to symptoms (n = 4). Most frequent sites of recurrence were liver (50%), lung (44%), multiple (22%) or locoregional (16%). Treatment of RD with curative intent was performed more frequently when detected during scheduled FU (60 vs. 22%). The only predictive factor for developing RD was stage III disease on initial presentation.
  
  
  CONCLUSIONS
  The majority of rectal cancer patients are diagnosed with RD at an asymptomatic stage during scheduled FU consultations. Only a few patients presented with RD outside the FU programme. Arguably, general practitioners could order these same diagnostic tests during FU.
authors.affiliation: Department of Primary Care, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Wieldraaijer
authors.forename: Pascal
authors.initials: P
authors.lastname: Bruin
authors.forename: Laura A M
authors.initials: LAM
authors.lastname: Duineveld
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Anke B
authors.initials: AB
authors.lastname: Smits
authors.forename: Henk C P M
authors.initials: HCPM
authors.lastname: van Weert
authors.forename: Jan
authors.initials: J
authors.lastname: Wind
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies
keywords: Clinical presentation; Follow-up; Patients; Rectal cancer; Recurrent disease