PURPOSE:Because the elderly population in Western countries is rapidly increasing, as is their life expectancy, studies aimed at determining the impact of major surgery for primary rectal cancer in this group are warranted. The purpose of this study was to compare perioperative morbidity and mortality and long‐term disease‐specific and overall survival in primary rectal cancer patients, older and younger than 75 years of age, subject to major pelvic surgery.METHODS:From September 1986 to December 1996, the Prospective Colorectal Service Database identified 1,120 consecutive patients who underwent major pelvic surgery for primary rectal cancer. Of these, 157 (15 percent) were 75 years of age or older and comprise the elderly group. From the remaining 963 patients younger than 75 years of age, a representative random sample of 174 was selected and constitutes the younger group. Data were obtained from computerized databases and confirmed via chart review and telephone interviews.RESULTS:Perioperative complications were observed in 53 (34 percent) elderly and 63 (36 percent;P=not significant) younger patients. Perioperative deaths occurred in two (1.3 percent) elderly and one (0.6 percent;P=not significant) younger patient. The median follow‐up time was 48 months. Although the overall survival was lower in the elderly group (P=0.02; the 5‐year overall survival rates were 51 and 66 percent), the disease‐specific survival rate was similar in the two groups (P=0.75; the 5‐year disease‐specific survival rates were 69 and 71 percent).CONCLUSION:In select individuals 75 years of age or older, major pelvic surgery for primary rectal cancer can be done with perioperative morbidity and mortality rates comparable to those obtained in younger individuals, while achieving excellent disease‐specific and overall long‐term survival.