PURPOSE:Eighty percent of local recurrence after resection of rectal adenocarcinoma classically occurs within two years of surgery. Pretherapeutic staging is frequently limited to clinical examination, although the accuracy of endoanal ultrasonography has been demonstrated. The aim of this study was to report the long‐term results of preoperative radiation therapy and resection of pretherapeutic endoanal ultrasonography‐staged T3 and T4 rectal adenocarcinoma.METHODS:This retrospective review analyzed a series of 113 patients who underwent radiation therapy followed by surgery. All patients underwent an endoanal ultrasonography. Median follow‐up was 75 months.RESULTS:Fifty‐seven percent of patients were pT3 or T4. Thirty‐six percent had involvement of lymph nodes. Five‐year rates of survival, local recurrence‐free survival, and disease‐free survival were 79, 73, and 68 percent, respectively. Ten‐year rates were 65, 63, and 62 percent, respectively. Median time to detection of local recurrence was 39 months. Eight of ten local recurrences occurred after two years of follow‐up. Eight of ten patients with local recurrence had pretherapeutic endoanal ultrasonography‐staged N+ tumors.CONCLUSION:These results appear to justify a follow‐up program for patients with pretherapeutic endoanal ultrasonography‐staged N+ tumor. However, a minimum of seven years of follow‐up is needed to obtain an accurate assessment of results.