The quality of life for patients with carcinoma of the lower two-thirds of the rectum (5–12 cm from the anal verge) treated by abdominoperineal resection (APER, n = 38) was compared with that of a similar group of patients treated by low sphincter saving resection (SSR, n = 40). Assessment was by questionnaire conducted a minimum of one year after operation. Thirty patients (75 percent) after SSR were entirely continent and ten patients (25 percent) had occasional episodes of incontinence. Each patient with a colostomy was incontinent and 25 (66 per cent) had leaks from their appliance (12 frequent; 13 occasional). Patients after APER avoided more items in the diet and took more medication to control their bowel habit than patients after SSR. Fifteen of the 18 patients (83 percent) who were employed before SSR returned to work after operation; only 6 of 15 patients (40 percent) returned to work after APER (P < 0.05). Sexual function was impaired in 6 of 20 men (30 percent) after SSR and in 12 of 18 men (67 percent) after APER (P < 0.06). Depression was significantly more prevalent after APER than after SSR. Patients with low rectal cancer who are treated by modern sphincter saving resection have a quality of life superior to those who are treated by APER.