OBJECTIVES: Both Low Anterior Resection (LAR) and Abdominoperineal Resection (APR) procedures are utilized to treat rectal tumors. There may be occasions when methods or devices may be utilized that could preserve communication to the anus and avoid conversion of an LAR to APR. We seek to compare the costs of LAR and APR procedures in comparable patient populations. METHODS: The Premier Perspective™ Database (PPD) was used to estimate the incidence and costs of LAR versus APR in the United States.  PPD is the largest hospital-based, database in the USA providing detailed resource utilization and cost data categorized under a patients’ principal and secondary diagnosis procedure codes.  Patients with procedure code for LAR or APR procedures between January 1, 2009 to June 30, 2010 were selected.  RESULTS: A total of 7999 patients with a procedure code for either LAR or APR were identified between January 1, 2009 and June 30, 2010.  APR was used in 1991 (25%) patients and LAR in 6008 (75%) patients.  Propensity score methodology was used to match LAR patients to APR patients based on patient’s demographics and hospital characteristics.  Mean cost per discharge was significantly higher in APR procedures compared to LAR procedures, $24,922 versus $21,709, respectively, p=0.0004.  OR time was approximately 54 minutes shorter for patients undergoing LAR compared to patients with APR procedures, 250 minutes vs. 304 minutes, respectively, (p<0.001).   Patients undergoing LAR procedures had a significantly shorter hospital length of stay, compared to patients who underwent APR procedures, 9 days versus 10.4 days, respectively, p<0.001.  CONCLUSIONS: LAR procedures were associated with shorter hospital lengths of stay, lower OR time and lower mean costs when compared to a matched set of patients undergoing APR procedures.  These observations highlight the potential cost advantages of further developing methods or instrumentation that would preserve anal function and avoid an APR.