Follow-up

Follow-up was performed every three to four months for the first year, every six months for the following five years, and thereafter annually, to detect any possible recurrence and to measure late toxicity. At every follow-up visit, both a digital examination of the rectum and a carcinoembryonic antigen test were performed. A hepatic ultrasound and chest X-ray alternated to an abdomino-pelvic CT scan with iv contrast every 6 months in the first year and every year thereafter. In addition, patients underwent their first colonoscopy 6–12 months following the surgery and every 3–5 years thereafter.

We evaluated the late toxicity in all patients including: gastrointestinal, renal-urinary, sexual, skin, neurological, cardiac and general. Late adverse events were recorded at 1, 3, 5 and 10 years after surgery and graded according to Common Terminology Criteria for Adverse Events score version 4 (CTCAE v4) [12].