With the promise of reduced surgical trauma and quicker recovery, laparoscopic surgery has gained popularity over the past 2 decades. However, the recent publication of the Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial (ALaCaRT)1 questions whether it is appropriate for rectal cancer. The study randomized 475 patients with rectal adenocarcinomas located within 15 cm of the anal verge to laparoscopic or open proctectomy. Stage T4 tumors, and tumors involving the circumferential radial margin (CRM) on preoperative imaging, were excluded. Fifty percent of patients received preoperative radiotherapy; 35% had low tumors (within 5 cm of the anal verge); 8% underwent abdominoperineal resection. Participating surgeons were required to provide evidence of expertise in laparoscopic colorectal surgery. Hybrid procedures, in which the abdominal dissection is performed laparoscopically and the pelvic dissection performed through a small incision, were permitted in the open group.