A major difference is noted between the recurrences of carcinoma of the rectum as compared with carcinoma of the colon; as for example, in the first three years following surgery, 6% of patients with carcinoma of the rectum showed systemic metastasis compared with 1% of those with carcinoma of the colon. The most likely avenues for spread are the middle and inferior hemorrhoidal veins. Accordingly, the authors recommend that ligation of the inferior mesenteric vascular pedicle be undertaken following mobilization of the rectum.