The incidence of rectal cancer in patients younger than 50 years is increasing. To test the hypothesis that the biology in this younger cohort may differ, this study compared survival patterns, stratifying patients according to National Comprehensive Cancer Network (NCCN) guideline–driven care and age. The National Cancer Data Base was queried for patients treated with curative‐intent transabdominal resections with negative surgical margins for stage I to III rectal cancer between 2004 and 2014.