The adoption of laparoscopic proctectomy for rectal cancer has been relatively slow, primarily because of the technical difficulty of the procedure. The wide surgeon-to-surgeon variability in disease-free survival and local pelvic recurrence noted after open proctectomy is probably due to differences in surgical technique, and these differences are likely to be magnified when the additional challenge of laparoscopy is added to the procedure. At present, oncologic outcomes data are sparse. However, given that the theoretic concerns regarding laparoscopic colectomy for colon cancer are likely to be allayed as data from large prospective trials become mature, the adoption of laparoscopic techniques to perform curative proctectomy will occur as technical challenges are overcome and experience and training improve.