Controversy still exists as regards the extent of lym-phadenectomy, the use of the no-touch principle, the optimal free distal margin and importance of the irrigation/washout of the rectal stump in radical surgical treatment of rectum. There is in fact no statistical scientific evidence to support any of these measures for improving the oncological cure rate. Neither is there any scientific evidence to support the importance of TME or that an AR for a low sited rectal cancer does not compromise "radicality". Randomised controlled studies are lacking and it is doubtful - for ethical reasons - if such studies will ever be done. It would be virtually impossible to organise such a trial of two operations (one of which inflicts and the other avoids a permanent colostomy) because of the difficulty of getting patients to agree to enter a scheme that might leave them with an abdominal anus.

"There are two different ways to determine the best kind of treatment for colorectal cancer, the first of which being the purely scientific way based on statistics and the second being a non-scientific way, the so-called 'gut feeling' decision, based on the question 'what operation would I myself prefer to undergo?'" [22].

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