Abstract: Objective To investigate the influence of risk factors in prognosis of elderly patients with rectal cancer, and to provide reference for improving the prognosis of colorectal cancer. Methods A total of 124 elderly cases of rectal cancer were selected in our hospital from January 2007 to January 2012 as research objects. The factors affecting the prognosis and survival rate were analyzed by the SPSS 17.0 software. Results The 1-, 3-, and 5-year survival rates for the 124 patients were 91.13%, 54.03%, 23.39%, the median survival time being 41 months; stage I + Ⅱ patients with 3 year survival rate accounted for the highest 85.71% of low differentiation, recurrent patients with 3 year survival rate were the lowest 11.54%. COX regression analysis showed that, TNM staging, distant metastasis, recurrence, and degree of differentiation had significant effect (P<0.05) in the prognosis of the patients Conclusion TNM staging, distant metastasis, degree of differentiation, and recurrence were independent risk factors in elderly patients with rectal cancer, which can be used as important evaluation indexes in the prognosis of the patients.