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In patients withprimary rectal cancer, tumour excision offers the optimum chance of cure. The aim of this study was to evaluate the outcome of patients withprimary rectal cancer treated at a single UK centre over a 9 year period.Aprospectively maintained database of 1020 consecutive patients withprimary rectal cancer treated between 1998 and 2007 was analysed.Of 870 patients without synchronous distant metastases, rectal excision was performed in 731 (84%), including anterior resection in 433 (59.2%), abdominoperineal resection (APR) in 192 (26.3%), Hartmann'sprocedure in 92 (12.6%) and colectomy/proctectomy in 14 (1.9%). Overall 30day mortality rate was 4.5% and 5-year survival rate 66%. Fifty-two patients had a defunctioning stoma only (8% 3 year survival). Of patientspresenting with synchronous metastases (n = 150), 90 (60%) underwent rectal excision, with overall 5-year survival of 12%.We report outcomes from surgical treatment of patients withprimary rectal cancer in a large series from a single UK centre. Thirty day morality, overall survival and APR rates are comparable with similar reports in the literature. Over half of patients with distant metastases atpresentation underwent excision of theprimary tumour, in many with a view to future metastasectomy.