A prospective surgical findings report shows that pelvic lavage CEA messenger RNA detected during curative rectal cancer operations independently predicts local pelvic recurrence. The study found CEA mRNA signal alongside circumferential resection margin status as an additional predictor. CEA mRNA detection is positioned as a molecular marker of residual disease risk at the surgical field, potentially improving post-op risk stratification beyond standard pathology. If validated in larger cohorts, pelvic lavage sampling could become an actionable intraoperative/early postoperative assay to guide surveillance intensity or adjuvant decisions.