<qa>  What is the cost of a higher risk of surgical complications?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. 