Ultra low resection versus abdomino-perineal excision in low rectal cancer

There have been several important improvements in the management of patients with rectal cancer during the recent 20 years. For more accurate local and distant tumour staging, introduction of neoadjuvant treatments, improved surgery, a more precise macroscopic and microscopic evaluation of the specimen and MDT discussions have all been crucial in improving local control and survival. However, the most important factor has been the TME technique with standardisation of the surgical procedure. For patients with low rectal cancer, the decision making is complex with several treatment options, including the choice between neoadjuvant treatment followed by surgery or surgery alone, restorative procedures or APE. If an APE is necessary, this must also be tailored to the individual patient based on patient's characteristics and the extent of local tumour growth.