Treatment of rectal cancer has changed substantially over the past decades, resulting in improved outcome. From a surgical point of view, the acknowledgment of the importance of the circumferential resection margin (CRM) and the concomitant introduction of total mesorectal excision (TME surgery) has meant a significant step forward in improving radical resection and thus improving both local control and survival [1]. Also, more accurate imaging modalities such as MRI have led to better patient selection enabling differentiated neoadjuvant treatment for the individual patient. Finally, the (neo)adjuvant therapy itself has become more potent in recent years as well [2].