Two hundred and eighty patients with previously untreated large bowel adenocarcinoma were retrospectively evaluated following complete primary resection to determine patterns of recurrence. One hundred and five patients (37%) subsequently developed recurrent disease. Sixty percent (63/105) presented with local recurrence alone, 14% (15/105) with concomitant local recurrence and distant metastases, and 26% (27/105) with distant metastases alone. Ninety-two percent of local recurrences developed in structures contiguous to the operative area of the incision. The degree of tumor anaplasia and depth of tumor penetration into the bowel wall influenced the rate of local recurrence. Through 5 years, local recurrence without clinical evidence of distant metastases was the most common cause of death. Plans for adjuvant radiation therapy are discussed.