The authors' experience with local excision (LE) and adjuvant radiotherapy in the treatment of selected cases of rectal cancer, is reported. 41 patients with distal rectal cancer underwent elective LE for cure. Selection criteria were: the site of tumor in the lower rectum, exophytic growth, maximum diameter equal to or lower than 4 cm, tumor "freely" mobile on the rectal wall, clinical staging T1-2 N0M0, histological grading G1-2. Patients shown to be T2 on definitive histology underwent adjuvant radiotherapy to the site of tumor and to pelvic lymph nodes. LE was performed via transanal route under general anesthesia. Operative mortality was 0% and morbidity 7.3%. In 37 cases (90%) surgery was considered radical and curative. The incidence of local recurrence was 5.4%, overall evidence of disease 8.1%, cancer-specific mortality 5.4% and 5-year actuarial survival 90%. The combination with radiotherapy has achieved similar results in T1 (22 cases) and T2 (15 cases) tumors. It is concluded that LE combined with radiotherapy in T2 tumors in selected cases represent a valid therapeutic alternative to more demolitive surgery.