Rectal Cancer – Towards Establishing a New Strategy of Treatment

and the pathologist evaluate macroscopically and classify the completeness of the rectal cancer resection specimen. Quality control of surgery provides the first prognostic information concerning local and distant recurrence [4, 5] . With such impressive results of local control and survival after TME, adjuvant radiotherapy and chemotherapy seem to offer no additional benefit. However, there are always patients at risk to develop local recurrence and distant metastases. These subsets include patients with lymph node metastases, venous or lymphatic vessels invasion, distally located tumors most likely requiring an abdominoperineal resection (APR) and, most importantly, a threatened by tumor extension circumferential margin of resection (CRM). It is established beyond any doubt that the status of the CRM is possibly the strongest predictive factor of local recurrence or even survival. A positive CRM, namely presence of tumor at a distance