We reviewed the charts of 4 patients with villous adenoma of the rectum seen at the First Dept. of Surg., Okayama Univ. Med. School between 1971 and 1990. This study included 2 men and 2 women, ranging in age from 52 to 83 years. Polypectomy was performed on 3 patients with villous adenoma and low anterior resection was performed on 1 patient. Recurrent tumors developed in one of the 3 patients who had undergone polypectomy. In addition, a series of 88 patients with villous adenoma of the rectum reported in Japan were also reviewed. The average age of the patients with villous adenoma was 62.9. There were 47 men and 41 women. The presenting symptoms of the 69 patients with tumor were mainly bleeding and watery or mucinous diarrhea. The tumor size and invasiveness of malignancy were also examined. The likelihood of malignancy correlated with size of tumor, and none of the lesions smaller than 2cm contained a malignant tumor site. Surgeons should consider the size, location and malignant change of the villous tumor with as much precise examination before and during operation so that unnecessary over surgery is avoided.