There are many ways by which the surgeon can optimize curative resection for rectal cancer. Appropriate margins with total mesorectal excision, should be the goals for tumors in the lower two-thirds of the rectum. Reconstruction should be performed, whenever technically possible, by a colonic J-pouch. Preservation of pelvic autonomic nerves is possible in most cases, reducing the risk of postoperative sexual and urinary dysfunction. New techniques increase the frequency of curative treatments of metastatic disease. Towards either the primary or the metastatic disease, the new therapeutic strategies offer an hope of cure, and a better quality of life, to an increasing number of patients.
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