OBJECTIVE To analyze the results and the prognosis of local excision of lower rectal cancer, and investigate the proper indication of local excision for cure purpose. METHODS The clinicopathological data of 76 patients with lower rectal cancer treated from February 1985 to October 2007 were analyzed. RESULTS Sixty-nine patients received transanal excision, 6 cases received trans-sacral excision and 1 case received trans-vaginal excision. Among the cases, 48 cases were ranged as T1 phase, 25 cases as T2, 3 cases as T3. The operation complication rate was 7.9%, and the 30-day mortality rate post operation was 0. The local recurrence rate was 22.4% and the overall 5 year survival rate was 84.5%. The local recurrence was significantly related with T stage and resection margin status. The survival was significantly related with mucinous adenocarcinoma, resection margin status and lymphovascular invasion; and the resection margin and lymphovascular invasion was the independent factors affecting survival. CONCLUSION Local excision was safe in early stage lower rectal cancer. Careful patient selection is the key of the operation. The proper indication of local excision is T1-2 without high risk factors (high histopathological grade, presence of lymphatic or vascular invasion, mucinous adenocarcinoma); and the cases with T2 phase tumor should undergo chemoradiotherapy after local excision.