Objective:The risk factors of local recurrence after curative resection were evaluated in patients with middle and lower rectal carcinoma. Methods:Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People’s Hospital were studied.The relationship between mesorectal metastasis/circumferential resection margin status and local recurrence was identified.The relationship between local recurrence and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. Results:Local recurrence after curative resection occurred in 12.5%(7/56) of patients with middle and lower rectal carcinoma.Local recurrence was associated with family history (P=0.047),high CEA level (P=0.026),cancerous perforation (P=0.004),tumor differentiation (P=0.009) and vessel cancerous emboli (P=0.001). Twelve patients (21.4%) had positive circumferential resection margin.Local recurrence rate of patients with positive circumferential resection margin was 333%(4/12),whereas it was 68%(3/44) in those with negative circumferential resection margin (P=0.014).Thirty-six (64.3%) patients was detected mesorectal metastasis.Local recurrence rate of patients with mesorectal metastasis was 16.7% (6/36),whereas it was 5.0%(1/20) in those without mesorectal metastasis.The difference between these two groups was not statistically significant (P=0.206). Conclusion:The results demonstrate that family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are significant risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma.