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Updated: Oct 25, 2025

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Early Versus Late Recurrence in Rectal Cancer: Does Timing Matter?

Marina Affi Koprowski1, Thomas L Sutton1, Nima Nabavizadeh2

  • 1Department of Surgery, Oregon Health and Science University (OHSU), 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
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PubMed
Summary
This summary is machine-generated.

Early recurrence (ER) in rectal cancer does not impact post-recurrence survival (PRS). Focus should shift to treating limited metastatic disease rather than time to recurrence (TTR) for better outcomes.

Keywords:
Rectal cancerRecurrenceSurvival

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • The definition of early recurrence (ER) in rectal cancer remains unclear.
  • The association between ER and post-recurrence survival (PRS) is poorly understood.

Purpose of the Study:

  • To determine if time to recurrence (TTR) is associated with PRS in patients with resected rectal cancer.
  • To investigate factors influencing PRS in rectal cancer recurrence.

Main Methods:

  • Retrospective review of 548 patients with nonmetastatic rectal cancer undergoing curative-intent resection (2003-2018).
  • ER defined as recurrence <24 months, late recurrence (LR) as ≥24 months.
  • PRS evaluated using Kaplan-Meier and Cox proportional hazards modeling.

Main Results:

  • 11.1% of patients experienced recurrence, with a median TTR of 14 months.
  • 74% of recurrences were classified as ER; no significant baseline differences between ER and LR groups.
  • ER was not associated with worse PRS (P > 0.99); symptomatic recurrence and elevated CEA were linked to worse PRS.

Conclusions:

  • Early recurrence (ER) does not negatively impact post-recurrence survival (PRS) in resected rectal cancer.
  • Symptomatic recurrences and elevated CEA are associated with worse PRS.
  • Metastatic disease limited to the liver or lung may be associated with improved PRS, suggesting a focus on treatable oligometastatic disease.