Objective The time to local recurrence of rectal cancer affects patient prognosis. Our study aimed to establish a clear threshold to distinguish between early and late recurrence and analyze their risk and prognostic factors.

Methods We conducted a retrospective selection and analysis of clinical data from 111 patients with locally recurrent rectal cancer (LRRC) who underwent proctectomy at Tianjin Medical University Cancer Institute & Hospital between January 2006 and December 2019. The minimum P-value approach and Log-rank test were used to determine the cut-off values of early recurrence (ER) and late recurrence (LR). Risk factors for early recurrence were analyzed using Logistic regression models, and prognostic factors associated with additional surgery were assessed using Cox proportional hazards models.

Results Based on the minimum P value approach, the optimal interval to distinguish early from late recurrence was 26 months (P<0.001). In the ER cohort, the median recurrence-free survival (RFS) was 14.1 months and post-recurrence survival (PRS) was 23.7 months. The median RFS of LR patients was 33.4 months, whereas the median PRS was 35.8 months. The 5-year survival rates in the ER and LR groups were 32.5% and 57.1%, respectively (P<0.001). In the univariate analysis, poor differentiation, positive lymph nodes, presence of lymphovascular invasion, and absence of radiotherapy enhanced the likelihood of early recurrence. Furthermore, only radiotherapy caused a significant difference in the multivariate analysis.

Conclusions Early recurrence of rectal cancer can be defined as recurrence within 26 months after radical surgery, and patients with early recurrence have a poorer prognosis.