The prognosis of patients with rectal cancer has been improved significantly after introduction of the total mesorectal excision (TME). Just by performing TME, the local recurrence rates could be decreased to less than 10%, independent of multi-modal therapeutic concepts. In contrast, the local recurrence rate reached 4 to 55% (median 20%) in a German multicenter study in 1995 prior to the nationwide introduction of TME. The goal of this overview is to compare the different concepts in the multi-modal therapy of rectal cancer with their advantages and disadvantages based on the current literature. Mentioned will be local recurrence rates and survival, but also toxicity, costs and acceptance of patients. Furthermore, a preview is given about future developments.