The ideal operation of rectal cancer excises the disease with minimal morbidity. The traditional abdominoperineal resection approach to rectal cancer was considered the surgical gold standard but significant morbidity in the form of mandatory stomas and nonhealing perineal wounds prompted a search for a better approach. Since about 1940, sphincter-sparing procedures, such as anterior resection, in appropriately selected patients have achieved equal or greater rates of survival and recurrence with the benefit of an improved quality of life. More recently, transanal local excision and coloanal anastomosis have been used with increasing frequency to spare the sphincter and cure the cancer.