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The aim of this study was to determine the risk factors affecting recurrence in patients with T1 colorectal cancer (CRC) treated with radical surgery and to evaluate the cost-effectiveness of surveillance for postoperative recurrence.Between 1990 and 2008, a total of 380 consecutive patients with T1 CRC underwent surgery in our institution. Clinicopathological factors associated with recurrence, and the costeffectiveness of surveillance for postoperative recurrence were analysed. Measurement of CEA and computed tomography were performed every 6 months. Colonoscopy was performed one year after the operation, and every 3 years thereafter.The median follow-up period was 52 (1-189) months. Postoperative recurrences were seen in 11 (3%) patients of whom two were alive and cancer free. Thepresence of lymphatic invasion was significantly associated with recurrence (P = 0.0008). The 5 and 10 year disease free survival rates for patients with N-ly-, N-ly+, N+ were 99.1%/99.1%, 95.4%/73.2%, 95.5%/95.5%, respectively. The total cost for surveillance was $450000 and the cost to detect a relapsed patient was $40000.Lymphatic invasion was an independent risk factor of recurrence in patients with T1 CRC. Postoperative intensive follow up for patients with pT1 CRC may be unnecessary.