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Patients managed by abdomino-perineal excision of the rectum (APER) as opposed to low anterior resection (LAR) have both an increased CRM involvement and tumour local recurrence (LR) rate. Proportions of rectal cancer managed by APER versus LAR vary widely in the published data. By reviewing patients treated for low rectal cancer at a single centre which employs an aggressive sphincterpreserving policy, this study assessed whether reducing theproportion of APERs would influence LR rates.All rectal cancers treated in a single tertiary referral coloproctology unit were retrieved from aprospectively maintained database. All tumours ≤ 6 cm from the anal verge were then reviewed.Six hundred and seventy-one patients were treated between 2002 and 2007. Of the 187 tumours ≤ 6 cm from the anal verge, 43 underwent APER (6% of all patients with rectal cancer, 23% of lower third tumours) and 82 LAR. Sixty-three percent received neoadjuvant treatment The isolated LR rate was 4.6% vs 3.7% (APER vs LAR). The median follow-up was 42.5 months (range 21-88).High rates of sphincterpreservation can be achieved with low local recurrence rates, by a tailored combination of specialist surgery and neoadjuvant therapy.