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How do our oldest patients cope with surgery for early rectal cancer?According to the Swedish Rectal Cancer Register, 3694 patients had surgery for stage I rectal cancer 1995-2006. Anterior resection, AR, n = 1947, abdominoperineal resection, APR, n = 982, Hartmann'sprocedure, n = 253, local excision n = 448, unspecifiedprocedure, n = 64. Uni-and multivariate analyses of risk-factors for non-cancer related death within 2 years were performed after rectal cancer surgery for stage I cancer.An increased mortality risk was associated with the following variables: age ≥ 80, HR 1.61 (CI 1.26-2.06); male sex, HR 1.85 (CI 1.47-2.32); local excision compared to AR in patients over 80 years, HR 1.67 (CI 1.24-2.24); Hartmann'sprocedure in all age-groups except the oldest, HR 1.95 (CI 1.41-2.71). The average age for local excision and Hartmann'sprocedure was 6 years higher compared with AR and APR.In stage I disease, survival after local excision equals that of abdominal surgery withpreoperative radiation, except among the oldest, in whom it has a poor outcome, possibly due to a selection of high ASA score and age, rather than tumour-stage.