SummaryThe 24 deaths among 137 cases in which abdominoperineal resection was done at Touro Infirmary and Charity Hospital in New Orleans from 1964 through 1969 are reviewed. Sixty‐two per cent of these deaths were those of patients more than 70 years old, and 16 per cent were those of patients more than 80 years old. As evaluated by cardiovascular, pulmonary, and renal status, 50 per cent of the patients who died are classified as having been poor risks preoperatively. Eight of the 24 (33.3 per cent) are evaluated as definitely not candidates for abdominoperineal resection. These patients should have been treated by more conservative measures, such as coagulation of the tumor or radiation therapy. Careful preoperative evaluation of operative risk and determination of the curative or palliative potential treatment are essential. No longer is abdominoperineal resection necessarily the best procedure for palliation in incurable cases of adenocarcinoma of the rectum.