The surgical treatment of rectal cancer is very challenging and is one of the most rapidly advancing. At this time, different varieties of treatment options exist and new surgical methods are being explored. Thanks to numerous great pioneers in colorectal surgery in the last century, surgery for rectal cancer has changed from being purely palliative to one that made this solid malignancy a curable disease in the vast majority of cases. The evolution path has started few centuries ago, with early efforts to relieve symptoms by limited excisions. With the evolvement of general anesthesia, more extensive resections were made possible and different approaches could be tried. With the accumulation of experience, tumor removal could be combined with conservation of bowel continuity, an option which was not possible earlier. Advances in the understanding of the pathophysiology of rectal cancer, has led to increasing chances of cure through adoption of different surgical principles. However, rectal cancer is still challenging and its treatment options continue to evolve. This chapter focuses on some important landmarks in the surgical treatment of rectal cancer and on some of those pioneers who have contributed to it and to shape the modern rectal cancer surgery.