Because of continued problems with local recurrence after surgery for rectal cancer, extended resection of lymph node-bearing tissue has been proposed, both to increase survival and to decrease local recurrence. Such extended resection has often been associated with increased long-term morbidity, particularly as regards urinary and sexual function. A comparative analysis of currently available data with such extended resections is presented, considering both survival and morbidity data, and contrasting these data with results obtained with conventional resection. While it is not yet clear whether extended resections do in fact increase survival, results are promising in several specific situations, and work in progress has been successful in diminishing long-term morbidity for many patients.