Predictors of Recurrence After Curative Surgery for Stage I–III Rectal Adenocarcinoma: A Single-Center Retrospective Cohort Study

Introduction Despite advances in multimodal therapy, local and distant recurrence remain major challenges in rectal cancer management. Preoperative MRI and pathological findings offer prognostic information on local burden of disease. However, the value of these factors in predicting recurrence is not fully defined. This study aimed to identify and reassess MRI and pathological predictors for recurrence in rectal cancer. Methods In this single-center retrospective study, patients with Stage I-III rectal cancer who received surgery with curative intent between 2014 and 2021 at a German referral cancer center were analyzed using univariate analysis. Results A total of 279 consecutive patients were included. After a median follow-up of 54 months, local recurrence (LR) occurred in 20 patients (7.2%) and distant metastasis (DM) in 44 patients (15.8%). Advanced pathological UICC stage was found to be significantly associated with both LR (p=0.003) and DM (p=0.002). After neoadjuvant therapy, tumor downstaging correlated with a markedly lower incidence of DM (p=0.010). A positive circumferential resection margin was found to be linked to a higher risk of DM (p=0.035). Conclusion Our study identifies tumor downstaging after neoadjuvant therapy as a prognostically relevant factor. This finding emphasizes the necessity of incorporating treatment response into postoperative risk stratification to tailor an individualized surveillance strategy.