Fifty-seven patients underwent local excision of an invasive distal rectal cancer as an initial operative procedure with curative intent. Five-year survival was 82.5%, and the rectal cancer specific mortality rate was only 10.5%. The level of wall invasion, vascular permeation, tumor ulceration, mobility, and differentiation were the criteria studied for prognosis. Poor prognostic factors included mucinous cell differentiation and full thickness invasion, and in these cases, abdominoperineal resection was recommended. None of the 27 patients without these adverse prognostic factors died from rectal cancer. The other factors did not appear to influence the outcome, and local excision of distal rectal cancer would be the treatment of choice in such selected patients.