Early results of resection with primary anastomosis for cancer of the mid-rectum using a new stapling instrument are reported. Thirty patients with an adenocarcinoma 7 to 12 cm from the anal verge were operated on. One patient died postoperatively from respiratory complications but with no sign of anastomotic dehiscence. Two patients had a clinically recognizable leak that closed spontaneously within 3 days. Three patients had roentgenologically demonstrable leakage but no clinical symptoms. On examination 2 to 11 months after operation, all patients were continent for feces as well as gas, and none had more than four bowel movements per day. In four patients, all with a roentgenologically demonstrable leak, a stricture developed at the anastomosis within 3 months after discharge. All four patients were successfully treated by dilatation. Resection with anastomosis by means of the stapling instrument is practical even at the lowest level, is far less time-consuming and does not require the same degree of training as low anterior resection with conventional suture anastomosis.