Surgeons need to know that only 62% of patients on watch and wait for rectal cancer adhered to optimal surveillance, raising concerns about early regrowth detection.

• 53 patients studied, median follow-up of 17 months.
• Younger patients (median age 54) were more likely to follow optimal surveillance (p = .04).

Surveillance failures commonly occurred within the first year, particularly missing the initial endoscopic or imaging exams.

• Lack of adherence may impact outcomes in patients undergoing nonoperative management.