The benefits of laparoscopic colon cancer resection, such as reduced morbidity and shorter hospital stay, have been clearly demonstrated. Laparoscopic rectal cancer surgery is thought to be more challenging. Some authors question the oncological outcome, the anastomotic technique and the complications. In this lecture, Dr. Tom Cecil discusses the difficulties and challenges of laparoscopic rectal cancer surgery within the context of his own personal experience and with regard to some of the current literature. He offers that laparoscopic and open rectal cancer surgery both have a role and that the challenge is to appropriately select according to the patient, technique and pathology.