AIM: Rectal cancer shows a high incidence in older patients, however, only few reports focused exclusively on rectal cancer with the exclusion of the surgery of the colon. This retrospective study aims to compare short-term and long-term outcomes for rectal cancer in patients more than 75 years old with that observed in younger patients. MATERIAL OF STUDY: Four hundred consecutive patients operated on for primary rectal adenocarcinoma were collected in a prospective institutional database and divided into two groups: group 1 (≥ 75 years, n =98); group 2 (<75 years, n= 302). Sphincter-saving restaurative proctectomy was the only procedure considered. Main clinical and pathological data, morbidity, clinical anastomotic leakage, reoperation rate, 30-day mortality, overall survival, and cancer-related survival were assessed and compared. RESULTS: In our experience, advanced age itself is not a contraindication for surgical sphincter-saving proctetomy in rectal cancer patients, although it is associated with higher morbidity and mortality. Overall survival is lower in patients over 75 age, but cancer-related survival is not different between the two groups. CONCLUSIONS: In our experience, advanced age itself is not a contraindication for surgical sphincter-saving proctetomy in rectal cancer patients, although it is associated with higher morbidity and mortality. Overall survival is lower in patients over 75 age, but cancer-related survival is not different between the two groups.