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This study aims to determine theprospect of using magnetic resonance imaging (MRI) of the pelvis as a tool in quality assessment of rectal cancer surgery as a supplement to the histopathological evaluation.MRI of the pelvis was performed in 36 patients identified from a population of 118 surgically treated with total mesorectal excision (TME) or partial mesorectal excision (PME) since august 2007. Imaging was evaluated by two experienced multidisciplinary team (MDT) radiologists with regard to residual mesorectal fatty tissue and level of anastomosis. Histopathological records, standardised photos and clinical records were assessed.Evidence of residual mesorectal fatty tissue was identified in 36% of patients. A specific high number was found in PME with 44%,primarily owing to coning of the specimen. Insufficient distance from tumour to anastomosis was identified in 78% of patients with PME. Pathological assessment documented absent mesorectal fatty tissue in 44% of cases and correlates to those found by MRI. Pathological records were revised in 14% of cases.Ourpreliminary data supports earlier work by depicting visible residual mesorectal fatty tissue, and suggests that MRI is a helpful tool in quality assessment of rectal cancer surgery and pathology. Further studies are needed.