A number of patients undergoing curative colorectal resection present with local recurrences that are not resectable at the time of diagnosis. Whereas these are predominantly perianastomotic, only a few are primarily anastomotic occurring at the suture line. A 65-year-old female with Dukes B2 adenocarcinoma of the sigmoid colon after a radical left hemicolectomy had further resections with stapled anastomosis at 12 and 22 months, for primary anastomotic recurrences. She remains well 54 months after initial surgery. The recurrent cancers were histologically similar and showed no features of microsatellite instability. The microenvironment at the anastomosis and the suture material must have contributed to this unusual course.