The procedure of choice for most pT1 and a few pT2 tumors in the lower-third of the rectum is excision or local endoscopic polypectomy. In 602 radically resected low rectal carcinomas, the local recurrence rate for LAR was 18% and for APE 17%. There was no difference in local recurrence for UICC stage I and II tumors with a small (less than or equal to 2 cm) versus a large (greater than or equal to 3 cm) distal margin. However, in UICC stage III B and III C there was a statistically significant difference between a small (56%) and a large (22%) distal margin for LAR, while the local recurrence was 29% for APE. LAR in stage III B + C should be performed only when a distal margin of 3 cm is guaranteed.