Regular follow-up programs after radical resections of rectal carcinoma have been introduced in numerous hospitals. The main goal of a regular follow-up program is the early diagnosis of tumor recurrence in the asymptomatic stage to allow further radical resection. We evaluated the efficiency (quote of further resections of asymptomatic tumor recurrences) of regular follow-up after resection of 288 rectal carcinomas. 88 patients developed recurrent disease (47 primary locoregional recurrence, 27 distant metastasis, 14 locoregional and distant recurrence). Only 31 patients were asymptomatic at the time of recurrence (metastasis 55.6%, locoregional recurrence 31.9%, local and distant recurrence 7.1%; p < 0.05). In 31 patients (13 asymptomatic, 18 symptomatic) further R0-resection was possible. Locoregional recurrences were resected more often following anterior resection than after abdominal perineal resection. With 13 radical resections of asymptomatic recurrence the efficiency of regular follow-up was only 4.5%. Therefore efficiency alone does not justify regular follow-up examinations. Follow-up still makes sense for psychosocial support, diagnosis of metachronous colonic carcinoma, treatment of postoperative complications and critical evaluation of the results of surgery. Furthermore the follow up data can be used to plan adjuvant therapy studies.