Aim: Incidence of rectal and rectosigmoid cancer has wide geographical variation. Disease pattern in developing countries is different from developed countries. This analysis was undertaken to describe patient profile and to review the outcome of adjuvant therapy for rectal and rectosigmoid cancer at Kuwait Cancer Control Center.Patients and Methods: We retrospectively evaluated rectal and rectosigmoid cancer patients diagnosed between 1998 - 2004. One hundred and ninety three patients with rectal and rectosigmoid cancer were included. Only 11% of the patients were diagnosed with stage I disease, 28% with stage II, 53% were stage III, and 7.9% were stage VI. About 76.6% underwent anterior resection while 23.3% underwent abdomino-perineal resection or Hartman procedure. Only 63.2% of the patients received radiotherapy, and of those only 36 patients had preoperative radiotherapy. Only 35.2% of patients received adjuvant chemotherapy. Results:The male to female ratio was 1.4 and the median age of the patients was 52.11 years. Cancer of the rectum constituted 64.2% while rectosigmoid cancer constituted 35.8% of the cases. About 17.7% had tumor located within 5 cm from anal verge. Locally advanced or metastatic disease were found in 67.6%. Tumor involving more than _ of the lumen circumference was found in 49.1% of cases. Liver was the most frequent site (14.5%) of metastasis followed by lung (4.1%). Well, moderately and poorly differentiated adenocarcinoma constituted 16.8%, 68.8% and 14.5% of the cases, respectively. The disease free survival was influenced significantly by the lymph nodes status and chemotherapy. Among the whole group, the local recurrence was 18.7%, while the disease free survival and overall survival were 42.7 and 90.04%, respectively. Conclusions: Rectal cancer in Kuwait differs from western countries with a high propensity for locally advanced tumors because of delayed referral and misdiagnosis.