OBJECTIVE Analysis of palliative cryosurgery in rectal cancer patients. METHODS Descriptive. METHODS Department of surgery, University Hospital Vrije Universiteit, Amsterdam, the Netherlands. METHODS Ninety-three patients (age: 45-92 years) underwent palliative cryosurgery for primary rectal cancer. They were excluded from surgical resection because of old age, accompanying disease(s), inoperability and the presence of hematogenous metastases. The palliative effect of cryosurgery on local symptoms was classified as good, moderate or none. The duration of palliation was calculated in relation to survival as a palliative index: the number of months of (moderate or good) palliation divided by the number of months of survival from the start of the treatment, multiplied by 100%. RESULTS In 58 patients (62%) there was complete relief of local symptoms with a palliative index of 87%. In 13 patients (14%) palliation was moderate and in 22 patients (24%) no palliation was achieved. The 50% survival duration in the 58 patients was 37 months. Especially symptoms of blood and/or mucous discharge could be easily alleviated. Good alleviation of local symptoms was associated with the extent of the primary tumour process. Palliative effect could be assessed after a few treatments. Patients with circular rectal tumours seldom had long term palliative effects of cryosurgery. CONCLUSIONS Cryosurgery for rectal cancer is a simple and safe treatment. It should be considered for alleviation of local symptoms in patients with rectal cancer who are unsuitable for radical surgery.