Skip to main content


Log in

Rectal Cancer Surveillance—Recurrence Patterns and Survival Outcomes from a Cohort Followed up Beyond 10 Years

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript



The intensity and duration of surveillance for rectal cancer after surgical resection remain contentious. We evaluated the pattern of recurrences in a rectal cancer cohort followed up beyond 10 years.


An analysis was performed on a retrospective database of 326 patients with rectal cancer who underwent curative surgical resection from 1999 to 2007. The above study duration was chosen to ensure at least 10 years of follow-up. Data on patient demographics, peri-operative details, and follow-up outcomes were extracted from the database. The pattern of recurrences and investigative modality that detected recurrences was identified. Patients were followed up until either year 2016 or the day of their demise.


Two hundred seventeen patients (66.6%) were male and 109 patients (33.3%) female. Median age was 64 years old. Close to a third of the patients received adjuvant therapy (34%). Among the 326 patients studied, 29.8% of (97/326) patients developed recurrence. 7.7% (25/326) had loco-regional recurrence while 22.1% (72/326) had distant metastasis. Median time to recurrence was 16 months (4–83) and 18 months (3–81), respectively. Computed tomography scan was the best modality to detect both loco-regional and distant recurrences (48% in loco-regional and 41.7% in distant metastasis). The most common site of distant metastasis is the lung (34.7%). The salvage rate for loco-regional and distant recurrences was 52 and 12.5%, respectively.


The predominant pattern of recurrence in rectal cancer is distant disease. Surveillance regimes may need to be altered to increase early detection of distant metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. (2015) American Cancer Society Cancer Statistics.

  2. Trends in Cancer Incidence in Singapore 2010–2014.

  3. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

    Article  Google Scholar 

  4. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin. 2003;53:5–26.

    Article  Google Scholar 

  5. Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005;241:829–36. discussion 36-8

    Article  Google Scholar 

  6. Hansen MH, Balteskard L, Dorum LM, Eriksen MT, Vonen B, Norwegian Colorectal Cancer G. Locally recurrent rectal cancer in Norway. Br J Surg. 2009;96:1176–82.

    Article  CAS  Google Scholar 

  7. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341:457–60.

    Article  CAS  Google Scholar 

  8. Ortholan C, Francois E, Thomas O, Benchimol D, Baulieux J, Bosset JF, et al. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer: evidence from randomized trials. Dis Colon Rectum. 2006;49:302–10.

    Article  Google Scholar 

  9. Pahlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjodahl R, et al. The Swedish rectal cancer registry. Br J Surg. 2007;94:1285–92.

    Article  CAS  Google Scholar 

  10. Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50:1783–99.

    Article  Google Scholar 

  11. Kobayashi H, Mochizuki H, Morita T, Kotake K, Teramoto T, Kameoka S, et al. Timing of relapse and outcome after curative resection for colorectal cancer: a Japanese multicenter study. Dig Surg. 2009;26:249–55.

    Article  Google Scholar 

  12. Chauvenet M, Lepage C, Jooste V, Cottet V, Faivre J, Bouvier AM. Prevalence of patients with colorectal cancer requiring follow-up or active treatment. Eur J Cancer. 2009;45:1460–5.

    Article  Google Scholar 

  13. Scheer A, Auer RA. Surveillance after curative resection of colorectal cancer. Clin Colon Rectal Surg. 2009;22:242–50.

    Article  Google Scholar 

  14. Edge SBBD, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed; 2010.

    Google Scholar 

  15. Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;23:8512–9.

    Article  Google Scholar 

  16. Scholefield JH, Steele RJ, British Society For G, Association of Coloproctology for Great B, Ireland. Guidelines for follow up after resection of colorectal cancer. Gut 2002; 51 Suppl 5: V3–5.

    Article  Google Scholar 

  17. Van Cutsem EJ, Oliveira J, Group EGW. Colon cancer: ESMO clinical recommendations for diagnosis, adjuvant treatment and follow-up. Ann Oncol 2008; 19 Suppl 2: ii29–30.

  18. National Comprehensive Cancer Network (NCCN) Guidelines in Clinical Oncology. 2016.

  19. Sargent DJ, Patiyil S, Yothers G, Haller DG, Gray R, Benedetti J, et al. End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT Group. J Clin Oncol. 2007;25:4569–74.

    Article  Google Scholar 

  20. Bouvier AM, Launoy G, Bouvier V, Rollot F, Manfredi S, Faivre J, et al. Incidence and patterns of late recurrences in colon cancer patients. Int J Cancer. 2015;137:2133–8.

    Article  CAS  Google Scholar 

  21. Broadbridge VT, Karapetis CS, Beeke C, Woodman RJ, Padbury R, Maddern G, et al. Do metastatic colorectal cancer patients who present with late relapse after curative surgery have a better survival? Br J Cancer. 2013;109:1338–43.

    Article  CAS  Google Scholar 

  22. Cottet V, Bouvier V, Rollot F, Jooste V, Bedenne L, Faivre J, et al. Incidence and patterns of late recurrences in rectal cancer patients. Ann Surg Oncol. 2015;22:520–7.

    Article  Google Scholar 

  23. Chiang JM, Hsieh PS, Chen JS, Tang R, You JF, Yeh CY. Rectal cancer level significantly affects rates and patterns of distant metastases among rectal cancer patients post curative-intent surgery without neoadjuvant therapy. World J Surg Oncol. 2014;12:197.

    Article  Google Scholar 

  24. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984;53:1354–62.

    Article  CAS  Google Scholar 

  25. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52:1317–29.

    Article  CAS  Google Scholar 

  26. Steele SR, Chang GJ, Hendren S, Weiser M, Irani J, Buie WD, et al. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon rectum. 2015;58:713–25.

    Article  Google Scholar 

  27. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2007: CD002200.

  28. Jeffery M, Hickey BE, Hider PN, See AM. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2016;11:CD002200.

    PubMed  Google Scholar 

  29. Primrose JN, Perera R, Gray A, Rose P, Fuller A, Corkhill A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA. 2014;311:263–70.

    Article  CAS  Google Scholar 

  30. Rosati G, Ambrosini G, Barni S, Andreoni B, Corradini G, Luchena G, et al. A randomized trial of intensive versus minimal surveillance of patients with resected Dukes B2-C colorectal carcinoma. Ann Oncol. 2016;27:274–80.

    Article  CAS  Google Scholar 

  31. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926–33.

    Article  CAS  Google Scholar 

  32. Hong YS, Nam BH, Kim KP, Kim JE, Park SJ, Park YS, et al. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014;15:1245–53.

    Article  CAS  Google Scholar 

  33. Borie F, Combescure C, Daures JP, Tretarre B, Millat B. Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a Markov model. World J Surg. 2004;28:563–9.

    PubMed  Google Scholar 

  34. Renehan AG, O'Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ. 2004;328:81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Min Hoe Chew.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

What does this paper add to the literature:

This paper studies a cohort of rectal cancer patients who have been followed up beyond 10 years after curative surgery. It provides insight on the incidence of recurrences beyond the usual 5-year follow-up duration and the recurrence patterns of rectal cancer to allow modifications of current surveillance regimes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, W.J., Tan, H.J., Dorajoo, S.R. et al. Rectal Cancer Surveillance—Recurrence Patterns and Survival Outcomes from a Cohort Followed up Beyond 10 Years. J Gastrointest Canc 49, 422–428 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI: