PURPOSE:This study was designed to determine functional outcomes and rates of survival and recurrence of coloanal anastomosis in rectal cancer patients.METHODS:Between 1981 and 1991, 117 patients underwent coloanal anastomosis. Fifteen percent of the patients had a J‐pouch; the rest had a straight coloanal anastomosis. Thirty‐eight percent had no diverting stoma. Median distance of the tumor from the anal verge was 6.7 cm.RESULTS:Local recurrence rate was 7 percent. Five‐year survival was fully 69 percent. Satisfactory fecal continence was achieved by 78 percent of patients; no J‐pouch patient had frequent incontinence. Sixty‐two percent of the patients had major (anastomotic leak = 18 percent) or minor complications; complications were not mitigated by a diverting stoma or worsened by adjuvant therapy.CONCLUSION:Although coloanal anastomosis is associated with a high chance of complications, the long‐term outcome, in terms of disease‐free survival and satisfactory function, is excellent.