In my work, I often encounter patients and their families asking me about rectal cancer surgery, especially about whether the anus can be preserved. The Miles procedure is commonly known as the stoma procedure, which does not preserve the anus. The Dixon procedure preserves the anus, and the traditional view is that its indications are: rectal cancer with tumor more than 5 cm from the anal verge, without extensive infiltration, with relatively good biological characteristics, and the anastomosis can be located more than 1 cm from the anorectal ring after tumor resection. With the in-depth research on rectal anatomy and physiology, pathology and biological characteristics of rectal cancer, as well as the development of surgical science and instrumentation to give patients more opportunities to preserve the anus while the tumor is eradicated, this procedure is also used for the treatment of certain low and ultra-low rectal cancers. In 1982, Heald introduced the concept of total mesorectal excision (TME), in which the fat, blood vessels and lymphatic tissue of the dorsal rectum wrapped by the dirty layer of the pelvic fascia are called rectal mesentery. In the past, blunt separation was used, which not only caused incomplete resection of rectal mesentery, but also spread and residual cancer cells, which may be the main reason for the high local recurrence rate after radical rectal cancer resection. 1986 Heald et al. first reported and emphasized total rectal mesentery resection. In 1992, they reported the results of a group of 152 cases of TME for rectal cancer, in which 42 cases of tumor distal resection ≤1 cm group had no recurrence after surgery; another 110 cases of distal resection >1 cm group had 4 recurrences after surgery (3.6%), and the local recurrence rate of the whole group was 2.6%, which set the record of the lowest recurrence rate in a large number of cases; again, it was pointed out that total rectal mesenteric resection was Again, it was pointed out that total rectal mesenteric resection was an important factor in reducing local recurrence. The implementation of TME technology has significantly increased the success rate of anus-preserving surgery for low rectal cancer, improved the results of radical rectal cancer treatment, enabled 90% of patients to obtain local disease control, and further improved the survival rate. The application of the anastomosis clutch in the 1980s also expanded the scope of anus-preserving surgery. Existing studies have shown that a distal incision margin of 2 cm or less does not affect patient survival and recurrence rates, so 2 cm from the lower edge of the tumor is now a widely accepted safe incision margin. In order to improve the efficacy, it is advisable to actively carry out preoperative adjuvant chemotherapy and radiotherapy to reduce the local recurrence rate, and also to reduce the stage and tumor size in some cases, so as to create conditions for anus-preserving surgery. After surgery, adjuvant chemotherapy should be continued to improve the long-term survival rate of patients and to improve the overall efficacy of rectal cancer through comprehensive treatment. If the tumor infiltrates the anorectal ring, invades the neighboring organs and is fixed in the pelvis, and is less than 2 cm from the anorectal ring, or the sphincter function has been weakened before surgery, it should be listed as an absolute contraindication to anus-preserving surgery. For low rectal cancer, anus-preserving surgery has the following benefits: 1. The risk of intraoperative rectal perforation and positive incisional margin can be reduced by 3 times. At TME, anus-preserving surgery is more anatomical and standard; transabdominal perineal rectal cancer resection breaks the anatomical barrier of the pelvic floor, producing a rough surface that may promote inflammation, abscesses, and local recurrence. 2.Because anus-preserving surgery reduces the damage to the autonomic nerve branches of the pelvic floor, reproductive function can be protected, which can significantly improve patients’ postoperative quality of life and does not affect their postoperative survival time. 3.Anal preservation surgery can maintain the body image. 65% of patients can obtain the integrity of the anus, thus preserving the functional integrity of the intestine.