PURPOSE:This study was designed to evaluate the clinical characteristics, surgical treatment, and outcome of carcinoid tumors of the rectum and to assess flow cytometry deoxyribonucleic acid (DNA) analysis as a potential prognostic factor for management of these tumors.METHODS:Medical records, tumor registry database, and pathology slides were retrospectively reviewed. Flow cytometry DNA analysis was performed on archived specimens.RESULTS:One hundred nine patients with rectal carcinoid tumors underwent surgery between 1962 and 1987. Follow‐up was available in 86 patients for a mean period of 12 years. Of 100 patients with tumors less than 2 cm, only one with a 1.5 cm ulcerated tumor developed liver metastases. Of nine patients with a tumor more than or equal to 2 cm, three with known liver metastases underwent rectal biopsy only, and three had rectal biopsy and laparotomy with biopsy of liver metastases. Three patients underwent radical resection. Following abdominoperineal resection, one patient died with local recurrence after 5 years, and one developed hepatic recurrence after 5.5 years and died at 9 years. One patient with coloanal anastomosis developed local and hepatic metastases seven years after surgery and died at ten years. No patients developed carcinoid syndrome. DNA ploidy did not correlate with metastases at presentation or recurrence of carcinoid tumor.CONCLUSION:Radical resection of rectal carcinoids with ulceration or size greater than or equal to 2 cm is associated with a poor prognosis; however, survival may be long term, even in the presence of metastatic disease. DNA ploidy does not appear to be a useful prognostic factor for rectal carcinoid tumors.