• For cancer of the middle and upper portions of the rectum it is possible to perform an abdominoperineal operation that includes ample resection of the affected tissues yet preserves the anal sphincters and spares the patient the misery of a permanent colostomy. Cancer of the lower portion of the rectum and the anal canal, on the other hand, requires a permanent abdominal colostomy and sacrifice of the anal sphincters. Abdominoperineal proctosigmoidectomy with preservation of the anal sphincters and without colostomy was done in 604 patients. Of the 24 deaths, 6 were due to peritonitis, 5 to pulmonary embolism, and 4 to myocardial failure. The figures for frequency of recurrence and for 5-year and 10-year survival showed that the operation was sufficiently radical. It permitted early discharge from the hospital and early return to work, and the patients are continent.