Total mesorectal excision (TME) has become the surgical standard of care for rectal cancer. Macroscopic assessment of mesorectal excision (MAME) using digital photography, affords a visual image for grading the completeness of TME (MA-0 to MA-2). Such a grading system can enhance the evaluation of the surgical baseline or platform used in randomized clinical trials, play a role in determining the need for adjuvant therapy in borderline situations (ie, T3N0M0 disease) or determine the care of patients who despite TME, might develop local recurrences.