The stage-adapted operative treatment of rectal cancer in the context of adjuvant therapy regimes necessitates accurate and, in times of diminishing financial resources, cost-effective preoperative staging. From January 1988, 424 patients with rectal cancer were examined by endosonography. In the same period 28 additional patients were staged by hydro-CT within a prospective study as the endorectal sonography probe could not be passed through the tumor stenosis. Sensitivity and specificity for T and N staging were equal or superior in the endosonography group. Compiled data in the literature for MRI staging of rectal cancer show results similar to those with endosonography. Therefore we see no indication for preoperative rectal staging methods other than endosonography unless the latter examination is technically impossible.