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To evaluate the accuracy ofpre-operative endorectal ultrasonography (ERUS) topredict pathological tumour stage in patients with rectal cancer undergoing surgical resection after chemoradiotherapy.Between January 2002 and March 2010, 127 consecutive patients with low-lying rectal cancer underwent ERUS staging after pCRT. Thepre-operative neoadjuvant treatment consisted of long-course radiotherapy with concurrent 5-fluorouracil (5-FU)-based chemotherapy. All patients underwent surgical resection with curative aim.The overall accuracy of ERUS in assessing the depth of tumor growth into the rectal wall was 52.0%. However ERUS accuratelypredicted goodprimary tumour response (ypT0-1) in 84% of cases with a PPV, and NPV of 70.6% and 89.2%, respectively.The strength of agreement between ERUS findings and pathology reports was moderate (κ = 0.60). The overall accuracy of ERUS for N-stage was 66.7%. The overall accuracy of post-chemoradiation ERUS for individual T-stage was unsatisfactory. However ERUS could be a useful tool for selecting rectal cancer patients with the potential for a good tumour response to pCRT.