The so-called rectal mesentery refers to the fat, blood vessels, lymph and connecting tissues around the rectum, and its importance in rectal cancer surgery had long been neglected. The rectum and rectal mesentery, wrapped by the dirty layer of pelvic fascia, constitute a unique anatomical unit in the pelvis, and local dissemination of rectal cancer generally does not exceed this area. In 1982, Heald et al. reported five cases of rectal cancer with multiple adenocarcinoma lesions found in the distal rectal mesentery at the lower border of the rectum. The authors emphasized that the dissemination of rectal mesentery is more dangerous than intraluminal dissemination, and it is easy to recur locally after surgery if the rectal mesentery is not completely resected. Therefore, the authors first proposed the concept of total rectal mesenteric resection, which was finally defined as a sharp separation along the plane between the visceral and mural layers of the pelvic fascia under direct vision, and complete resection of the visceral fascia medial to the right and left inferior abdominal nerves, as well as its encapsulated malignant tumor and rectal mesentery up to the level of the levator muscle. After more than 20 years of clinical practice, many remarkable efficacy of TME has been recognized: ①. Even with adjuvant radiotherapy and chemotherapy, it is difficult to achieve such ideal results with traditional surgery. ②, increase the chance of anal preservation: TME increases the possibility of preserving the sphincter by about 20%-25%. (iii) Easy preservation of pelvic autonomic nerves, reducing postoperative urination and sexual dysfunction. (iv) Reduce the need for adjuvant therapy. ⑤. No increase in distant metastasis rate and surgical mortality. ⑥.Other: reduce blood loss and avoid blood transfusion. Miles has long been considered the “gold standard” of surgical treatment for rectal cancer, but considering its destructive nature and impact on urination and sexual function, it is inappropriate to consider it as the “gold standard”. It is inappropriate to consider it as the “gold standard” considering its devastating effects on urination and sexual function. Nowadays, TME is increasingly becoming the new “gold standard” of surgical treatment for rectal cancer. However, TME has its shortcomings: 1) it is technically demanding, difficult to perform, and takes a relatively long time to perform. Moreover, the need for anastomosis increases accordingly. The chance of postoperative anastomotic fistula increases, and a temporary colostomy should be made for low anastomosis (within 6 cm from the anal verge). (③Postoperatively, different degrees of defecation dysfunction are likely to occur, and those who perform low (or ultra-low) anterior resection plus TME should undergo colonic J-pocket low rectal or anal canal anastomosis. Conclusion: TME should be routinely performed for middle and lower 1/3 segments of rectal cancer, and mesenteric resection of upper 1/3 segments of rectal cancer up to 5 cm distal to the primary tumor is sufficient.