The aim of this retrospective study is to compare the outcome of abdominoperineal excision (APE) and anterior resection (AR) for rectal cancer in terms of local tumor recurrence. A further comparison has been carried out between hand-sewn and stapled anastomosis; 147 patients have been followed for at least 2 years: 69 after APE and 78 after AR, 40 being stapled. The following variables potentially related to the risk of recurrence were evaluated: age, grading, staging, and site of the tumor. An overall 2-year local recurrence rate of 11 percent after APE and 12 percent after AR was observed, whereas it was 13 and 11 percent following stapled and hand-sewn sutures, respectively. Both differences were not statistically significant. A similar local recurrence rate was noted after APE and AR when the patients were matched for Dukes' stage and grading of the lesion. A trend toward an increased risk of recurrence following AR (P = 0.07) was shown when comparing the two procedures if mid and upper rectal cancers were grouped together. In the patients with anastomotic leaks after AR, no increase of local recurrence was observed. In conclusion, AR is unlikely to be followed by an increased risk of local recurrence and, therefore, when oncologically indicated, may be considered the operation of choice in the treatment of rectal cancer, although the possible risk of its overuse should be taken into account.