The addition of neoadjuvant chemoradiation to mesorectal excision significantly increased the rate of pelvic sepsis. This was particularly true for anastomoses in the lower third of the rectum. Fecal diversion should be considered in these patients.

Recent evidence suggests that intensive follow-up after curative resection of colorectal cancer is associated with a small but significant improvement in survival. Regimens that employ cross-sectional imaging and carcinoembryonic antigen determination appear to have the greatest benefit. A risk-adapted approach to follow-up, intensively following patients at highest risk of recurrence, increases efficacy and cost-effectiveness. Ongoing improvements in risk stratification, disease detection, and treatment will increase the benefits of postoperative surveillance. Large randomized controlled trials are needed to determine the optimal surveillance regimen and must include an analysis of survival, quality of life, and cost-effectiveness to assess efficacy properly.KEYWORDS: Colorectal neoplasm, neoplasm recurrence/detection, neoplasm metastasis/diagnosis, surveillance, follow-up, survivalObjectives: Upon completion of this article, the reader should be able to: (1) describe the primary and secondary goals of surveillance following curative resection of colorectal cancer; and (2) summarize the evidence in favor of intensive surveillance, recognizing its limitations and the issues that need additional clarification.