The introduction of the total mesorectal excision (TME) has changed the treatment of rectal cancer dramatically by reducing the local recurrence rate. We report the results of 208 patients undergoing a low anterior resection (LAR, n = 180) or abdominoperineal resection (APR, n = 28) with TME between 1 October 2001 and 30 September 2003. No adjuvant therapy was administered to any patient; however, 108 patients received neoadjuvant radiotherapy or radiochemotherapy. Since February 2002, 51 patients underwent a short-course radiotherapy with 5x5 Gy prior to surgery in cases of a T3 tumor or positive lymph node in the preoperative CT-scan or endoanal ultrasound. Patients with a T4 tumor or T3 tumor close to the sphincter received radiochemotherapy. We discuss the results for mortality, morbidity, functional outcome, and overall survival between the LAR and APR groups. The mortality rate was 3% in the LAR and 0% in the APR group, whereas the morbidity was higher in the APR group. Anastomotic leakages occurred in eight patients (7%), and reoperations had to be performed in 14 LAR and four APR patients. After a median follow-up of 11 months, the overall survival was 93% for LAR and 89% for APR. To assess the functional outcome after TME, questionnaires were sent to all patients undergoing LAR and APR. In conclusion, the TME has become the gold standard for rectal cancer surgery. Neoadjuvant treatment modalities such as preoperative short term radiotherapy (5x5 Gy) or combined radiochemotherapy will most likely replace the adjuvant combined radiochemotherapy.