BACKGROUND Over the past 20 years there have been many changes in the management of rectal cancer. Their impact on the overall population is not well known.

AIMS To determine trends in management and prognosis of rectal cancer in two French regions.

SUBJECTS 1978 patients with a rectal carcinoma diagnosed between 1978 and 1993.

RESULTS Over the 16 year period resection rates increased from 66.0% to 80.1%; the increase was particularly noticeable for sphincter saving procedures (+30.6% per four years, p=0.03). The percentage of patients receiving adjuvant radiotherapy increased from 24.0% to 40.0% (p=0.02). The proportion of patients with Dukes’ type A cancer increased from 17.7% to 30.6% with a corresponding decrease in those with more advanced disease. Operative mortality decreased by 31.1% per four years (p=0.03). All these improvements have resulted in a dramatic increase in relative survival (from 35.4% for the 1978–1981 period to 57.0% for the 1985–1989 period).

CONCLUSIONS Substantial advances in the management of rectal cancer have been achieved, but there is evidence that further improvements can be made in order to increase survival.