e16105 Background: Regarding cancer care, health system in Mexico is characterized by heterogeneous medical and technical infrastructure among institutions. Limited access to specialized surgeons, radiation therapy and medications may differ and affect survival. Our institution has surgeons, medical oncologists and radiation therapy for the treatment of uninsured low-income patients with RC. The institution does not provide chemotherapy or biologic therapy. Our aim was to describe treatment modalities and outcomes in patients (pts) with RC treated in a referral center in Mexico. Methods: A retrospective database of all consecutive pts with histological diagnosis of rectal adenocarcinoma evaluated at our institution from January 2010 to December 2016 was created. Clinical and pathological variables at diagnosis and treatment modalities were recorded. Overall survival (OS) was estimated using Kaplan-Meier method and compared by log rank test. Results: 99 pts were included, 61.6% male gender. Median age was 61 y/o (range 19 – 97). EGOG PS 0 – 1: 86%. 69% were moderately differentiated. Tumor location: lower (25%), middle (57%), and upper third (18%). Clinical stage (CS) was localized (T1-2, N0 M0) 5%, locally advanced (T3-4, or N+) 71% and advanced (M1) 24%. Treatment modalities (TM) by stage are presented in the Table. For those with advanced disease, 58% had metastasis in one site. RAS and BRAF mutation determination was performed in 21%. 5-year survival rate: 56%. Median OS (months): 25.3 for localized, 103.1 for locally advanced and 18.6 for advanced disease (P = 0.001). Conclusions: In our center, pts with local and regional RC had treatment according to international guidelines and survival was not compromised. On the contrary, limited access to systemic therapy affected patients with advanced disease and decreased survival was documented. To improve survival in patients with advanced disease, health policy adjustments to incorporate systemic treatment coverage are required. [Table: see text]