Extramural venous invasion (EMVI) is widely regarded as an adverse prognostic feature in rectal cancer. Whist the effect of venous invasion has been studied for more than seven decades, Talbot's study from St. Mark's hospital in 1980 was the first to specify the importance of extramural versus intramural venous invasion; and show that it was only invasion of tumour into the extramural veins that had a prognostic effect (1). However the current literature is somewhat confusing, which is most likely due to heterogeneity of definitions. This article is protected by copyright. All rights reserved.