In the upper rectum cancer, exeresis is performed extra-fascially, always outside the fascia recti, with the section localized 5 cm under the lower pole of the tumour. In lower rectum cancers, the resection includes the extra-fascial exeresis of the entire mesorectum and the section of the rectum 2 cm of the lower side of the tumour. Abdominoperineal amputation is needed in cancers in which the lower pole is too close from the anal canal (anorectal junction cancers) and all the more in those invading the sphincter apparatus. Some selected cases of ano-rectal junction lesions, treated in specialized centres, may need conservative treatment with inter-sphincter resection and coloanal anastomosis. Schematically, depending on the tumour site, four different proctectomy techniques have been described, all with preservation of the anal sphincter: 1) partial proctectomy with a partial exeresis of the mesorectum followed by a manual or mechanical upper colorectal anastomosis; 2) partial proctectomy with complete exeresis of the mesorectum, followed by a lower colorectal anastomosis in case the rectal stump is > 2 cm, and by a mechanical colo-supra-rectal anastomosis with colonic reservoir in case the rectal stump is < 2 cm; 3) total proctectomy with a complete exeresis of the mesorectum followed by a manual colo-anal anastomosis on the reservoir, performed by perineal route; 4) a new technique adapted from that of Babcock, which associates total proctectomy and the colon lowering and exteriorisation through the anus, followed after 5 days, by a resection of the lowered colon and a direct manual coloanal anastomosis by perineal route. In the abdominoperineal amputation of the rectum, an exeresis of the anal canal and the sphincter apparatus is added followed by a definitive colostomy. This procedure is characterized by some particularities, among which the possibility of preservation of the sigmoid pedicle or its first part in particular in aged subjects, and its frequent association with a pedicle epiploplasty on left gastro-epiploic vessels. Coelioscopy may be used with all these techniques. All may be initiated by coelioscopy, then turn to laparotomy especially in case of a prolonged procedure, or because of a technical difficulty, an exposition defect, or doubtful quality of lateral margins. Abdominoperineal amputation constitutes a good indication for coelioscopic approach because the only incision is the stomy, exteriorisation being performable through the perineum.