Is intensive follow-up really able to improve prognosis of patients with local recurrence after curative surgery for rectal cancer?

Background: Because more than 90% of local recurrences after curative surge ry for rectal cancer appear within the first 36 months after surgery, an in tensive and strict follow-up program during this period could improve early diagnosis and, thus, prognosis of patients. Methods: Of the 216 patients who underwent surgery for rectal cancer, 127 e ntered an intensive follow-up program (median follow-up: 42 months); the cl inical outcome of the remaining 89 patients was reconstructed with the help of their general practitioners. Results: Fifty eight (26.8%) of the 216 patients who were treated with cura tive surgery alone developed a local recurrence; pelvic recurrences were pr evalent. Eleven (30.5%) of the 36 patients who had recurrence during follow -up, and 6 of the 22, who had not undergone follow-up, had a reoperation wi th curative intent; the median survival was 19 months vs. 8 months, respect ively (P = ns). Four (44.4%) curative reoperations were performed on the 9 asymptomatic patients and in 13 (26.5%) of the 49 cases with symptomatic lo cal recurrences. Median survival was 15 months vs. 14 months, respectively (P = n.s). All patients except one (living after 42 months from reoperation ) died within 48 months. Conclusions: In our study, adherence to a strict follow-up program unfortun ately proved to be ineffective for improving long-term survival for patient s who underwent reoperation with curative intent.