The outcome of 555 patients who underwent surgery under the care of a surgeon with an interest in colorectal disease was examined prospectively over a 10-year period with no exclusions. There was a 4.7 percent incidence of clinical leaks (10 percent for anterior resection) and an overall corrected 10-year survival rate after curative surgery of 58, 59 and 48 percent for right colonic, left colonic and rectal tumours respectively. The incidence of isolated local recurrence was 8 percent after curative surgery for carcinoma of the rectum. Twenty-five percent of patients with rectal tumours required abdominoperineal excision. Patients who underwent curative abdominoperineal excision of the rectum had corrected 5- and 10-year survival rates of 48 and 36 percent, compared with 60 and 58 percent respectively for curative anterior resection. The perioperative mortality rate of those undergoing palliative surgery was 8 percent, and 75 percent died within 2 years from distant and not local disease. A policy of always attempting resection was validated by the fact that 99 percent of primary tumours were removed with a low perioperative mortality rate (4 percent overall), a high curative resection rate and a low morbidity rate.