Regarding the radical resection of low rectal cancer, whether to preserve the patient’s original anus or to remove the original anus plus a permanent abdominal colostomy, i.e., to reroute the tumor, is not only a matter of serious consideration and concern for the patient and his family, but also a matter that the surgeon must consider carefully. Only a surgeon with sufficient courage and commitment (i.e., the courage to do this type of surgery and adequate scientific understanding of this type of disease) can successfully complete this type of surgery. The responsibility and, more importantly, the risk that the surgeon assumes here is something that the patient cannot imagine or appreciate. In fact, whether it is anal excavation surgery or anal preservation surgery, both of them have the possibility of postoperative cancer recurrence or metastasis, which cannot be predicted in advance clinically, and the incidence is possible from 0% to 100%. Moreover, the possibility of tumor recurrence and metastasis after surgery is not directly related to the surgical method. However, radical resection of tumor can preserve patients’ original functions (defecation, urination and sexual function), and the postoperative quality of life is a world of difference, so as a bold and responsible surgeon, we should do our best to achieve the best of both worlds and give patients the greatest humanistic care. In addition, it is a matter of opinion whether a temporary colostomy must be performed at the same time as the radical anus-preserving surgery for low rectal cancer, because there is still the possibility of an intestinal anastomotic fistula when the temporary colostomy is returned. Also, prophylactic enterostomy does not reduce the incidence of anastomotic fistula. Therefore, as a mature and scientific surgeon, we should give our patients the utmost humane care and do our best to complete the surgery. Our medical philosophy is: cherish life, cure disease, preserve function, and live happily!