High local recurrence rates were a major problem in rectal cancer treatment, with between 30 and 50 % of patients affected, resulting in a very poor quality of life and short survival of patients with rectal cancer. In recent years, prognosis of rectal cancer has markedly improved, due to innovations in surgical treatment in combination with neoadjuvant therapy. Quality evaluation of surgical procedures has become the standard; constant high quality of surgery is one of the major successes in rectal cancer over the last decade. Continuous monitoring of surgical procedures is a new role for the pathologist. Completeness of excision, resection margins, but also numbers of lymph nodes have been firmly established as quality indicators.