Aim: Vascular adhesion molecule 1 (VCAM-1) plays an important role in solid tumor enlargement and/or metastases. This study evaluated the clinical significance of measuring serum levels of soluble VCAM-1 in rectal cancer and aimed to clarify the biologic significance of its local expression. Method: Serum was collected from 90 patients with rectal cancer and 40 healthy volunteers. Cancer tissue was collected from 84 patients. The level of soluble VCAM-1 in serum and cancer tissue was measured enzyme linked immunosorbent assay. Result: The mean soluble VCAM-1 level in patients was significantly higher than that in control subjects. Elevated serum soluble VCAM-1 was significantly associated with clinicopathologic paramaters such as tumor size, lymph node metastasis, distant metastasis, and poor prognosis. The prognosis for stage 2 patients positive for soluble VCAM-1 level was comparable to that for stage 3 patients. In addition, the serum level of soluble VCAM-1 level was not found correlation with the cancer tissue level. Conclusion: The preoperative level of soluble VCAM-1 level reflected disease progression and was a sensitive biomarker for rectal cancer.