Radical rectal resection is a crucial element in the multimodal treatment of rectal cancer. Tumor stage, tumor location, and patient characteristics are critical for selecting resection procedures. Therefore, an exact preoperative diagnostic workup is essential. Postoperative complications, such as anastomotic insufficiency or low anterior resection syndrome (LARS), may impact the oncological outcome and quality of life. In some cases, a clinical complete response (cCR) can be achieved by multimodal treatment (e.g., total neoadjuvant treatment, TNT). These patients can be included in a watch-and-wait strategy without resection.