Computed tomography in early diagnosis of local recurrence of rectal carcinoma

Local recurrence is a common problem among patients treated surgically for adenocarcinoma of the rectum and rectosigmoid. When a local recurrence has become clinically manifest, curative therapy is virtually impossible. Asymptomatic local recurrences are difficult to find clinically, especially in patients treated with an abdominoperineal resection. In 177 patients who had undergone locally curative surgery and had had an uneventful recovery, a postoperative follow-up program, including computed tomography (CT), was carried out. In 77 per cent (137/177) a mass was observed in the pelvis at the first postoperative CT. This mass partly represents fibrosis due to radiation therapy. The risk of developing local recurrence cannot be foreseen from a CT image. CT should not be performed by routine but only in patients with symptoms in whom local recurrence cannot be verified by clinical examination, and always with CT-guided needle biopsy of the detected mass.