ABSTRACT
Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently; only two academic general surgery departments included a specialist colorectal unit; and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with; and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality; with poor oncological outcomes. Repeatedly; outcome has been shown to be worse in the hands of generalists; rather than specialist colorectal surgeons; of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers