Background: A major goal of surveillance following curative resection for CRC is identification of treatable recurrence. However, there is a paucity of data regarding optimal frequency or duration of surveillance or potential for salvage therapy following detection of recurrence. The aim of this study was to examine treatment patterns following recurrence of CRC. Methods: Patients ≥ 18 years who presented to 8 participating NCCN institutions between 2005-2012 with resected stage I, II, or III CRC were identified. Time to recurrence was determined by the Kaplan-Meier method and descriptive statistics were used to report treatments following recurrence. Results: Of 5653 patients who underwent resection for locoregional CRC (2984 colon, 2669 rectal and rectosigmoid), median age was 60 [IQR: 50-70]. 53.5% were male. With a median follow-up time after diagnosis of 23.5 months (11.0-45.2), 641 recurrences (6.9% local; 93.1% distant) were identified. Median time to local recurrence was 16.1 months [IQR: 12.5-27.3]. Median time to distant recurrence was 15.6 months [IQR: 11.2-23.9]. Among 325 recurrences of a colon primary, 18 (5.5%) were local and 307 (94.5%) were distant; liver and lung were most common sites (30.8% and 13.9%, respectively). Among 316 recurrences of a rectal primary, 26 (8.2%) were local and 290 (91.8%) were distant; lung and liver were most common sites (35.8% and 21.8%, respectively). Of 597 patients who developed a metastatic recurrence, 227 (38.0%) underwent metastectomy (79 liver and 76 lung resections) and 26 (4.3%) underwent ablation. 414 (64.6%) received chemotherapy and 64 (10%) received radiation. 133 (20.7%) died without treatment < 1 year after recurrence. Of 641 patients,113 (17.6%) had synchronous sites of recurrence and 152 (23.7%) developed recurrence at a second site within 12 months. Conclusions: A high rate of metastectomy was observed following detection of recurrence within the NCCN hospitals. However, a significant proportion of patients had a second site of recurrence < 12 months after initial recurrence. Further inquiry into optimal surveillance and management of recurrence for patients following curative resection of CRC is needed. (Support: U10CA180821, CE-1304-6543).