 The combination of preoperative chemoradiotherapy and total mesorectal excision TME has been shown to reduce the risk of local recurrence in patients with resectable adenocarcinoma of the rectum1-6. The improved local control rates come at the price of an increased risk of surgical complications, including a postoperative death rate of 2-8 percent7, 8, which may reach 30 per cent at 6 months in those aged over 85 years9, as well as long-term impact on anorectal, urinary and sexual function10, 11. Patients with cancers in the low rectum in close proximity to the sphincter muscles, may require a permanent stoma, which can be associated with high psychological morbidity. 