Background: The use of laparoscopic resection for the treatment of rectal cancer has been widely used. However, strong evidence suggests that laparoscopic surgery and open dissection have similar prognosis and limitations in the treatment of rectal cancer. We designed the trial to compare the recurrence and survival of patients with rectal cancer that had metastasized to the pelvic or perineal sites (local metastases) after undergoing laparoscopic surgery or open dissection over a three-year period. Methods: In this international trial involving 30 hospitals, we randomly assigned patients with a single rectal adenocarcinoma within 15 cm of the perineum (no tumor invasion of adjacent tissues and no distant metastases) to undergo laparoscopic surgery or open dissection in a ratio of approximately 2:1. were the number of patients who recovered and the number of all patients who survived. Results: A total of 1044 patients participated in the trial, of which 699 patients underwent laparoscopic surgery, which we call the experimental group, and 345 patients underwent open dissection, which we call the control group. The rate of local tumor recurrence after surgery was 5.0% in both groups at 3 years (difference 0, 90% confidence interval -2.6 to 2.6); the proportion of patients who recovered and recovered was 74.8% in the experimental group and 70.8% in the control group (difference 4.0%, 95% confidence interval -1.9 to 9.9). The survival rate was 86.7% and 83.6% in the experimental and control groups, respectively (difference 3.1%, 95% confidence interval -1.6 to 7.8). Conclusion: The experimental results showed that if patients with rectal cancer were operated on, there was no significant difference between the two in terms of postoperative tumor recurrence, cure, and survival of patients after using laparoscopic or open cesarean surgery.