Vascular endothelial growth factor-C (VEGF-C) is considered to be a specific factor promoting lymphangiogenesis. There have been reports of a positive correlation between local recurrence of rectal carcinoma and lymphatic invasion by the tumor. The aim of this study was to determine the clinical significance of VEGF-C expression for identifying lymphangiogenesis as a predictor of the local recurrence of rectal carcinoma. One hundred surgical specimens of rectal carcinoma from patients with (n=26) or without (n=74) local recurrence were studied. VEGF-C protein expression was assessed immunohistochemically. The correlations between VEGF-C expression, various clinicopathologic factors, the microscopic lymphatic vessel density (MLVD), and lymphatic invasion were studied. The MLVD (determined by immunohistostaining for D2-40) was significantly higher in VEGF-C positive tumors than VEGF-C negative tumors. VEGF-C positivity was only correlated with lymphatic involvement. Moreover, multivariate analysis showed that VEGF-C protein expression was an independent risk factor for the local recurrence of rectal carcinoma, and patients with VEGF-C positive tumors had a significantly worse prognosis than those with VEGF-C negative tumors. Expression of VEGF-C may be a good predictor of the local recurrence of rectal carcinoma and may also be a useful prognostic indicator.