Inflammatory bowel diseases and rectal cancer may appear quite different at first glance. The former affect predominantly young people and results from an overactivation of the immune system, the latter peaks in the second half of life and may be seen as a failure of our immune system to identify and destroy aberrant cells. However, IBD and rectal cancer have more in common than they differ: both are best addressed in an interdisciplinary, interprofessional care environment, both benefit from rapidly evolving translational research, both require specialized care, commitment, leadership, and shared decision-making to achieve best outcomes. In the first part of this lecture, we will discuss surgical options for Crohn and colitis patients in the perioperative context, highlighting management pearls and basic technical points. In the second part, we will address the surgical management of rectal cancer and contemporary solutions and avenues for research, both in the clinical context and related translational approaches.