capable of anticipating the pathology with sufficient accuracy to identify the degree of
risk of local recurrence before treatment. This has allowed the rational development of
management strategies whether they include neoadjuvant chemoradiotherapy or less invasive
surgery such as local excision. Improved staging has also been at the centre of the
move from excisional to restorative major surgery, with total mesorectal excision inspiring
more careful dissection mindful of the locoregional pathology.While survival
and freedom from local recurrence are the main end-points of treatment, function has
become increasingly important as part of the measure of quality of life.