With the increasing interest in sphincter preservation in the treatment of low rectal carcinoma, we retrospectively reviewed the present surgical options--sphincter preservation with colo-anal anastomosis, and the radical abdominoperineal resection (APR). Seventeen patients had sphincter preservation with colo-anal anastomosis and 12 an APR; 53% of the sphincter preservation group survived, compared with 25% of those patients who had APR. We conclude that in selected cases sphincter preservation would not compromise the chance of cure and would save the patient from a permanent colostomy.