Rectal cancer has a high mortality rate and poor prognosis, most of the rectal cancers presented are progressive rectal cancers, and most of these patients recur and metastasize after radical surgery for rectal cancer. It is one of the most common malignant tumors of the digestive system. It accounts for about 40%, and in recent years, the incidence of rectal cancer in China is on the rise and young trend. The occurrence, development and regression of rectal cancer are closely related to apoptosis. The deregulation of apoptosis can lead to imbalance of cell proliferation, which is often considered as one of the mechanisms of tumor formation. In-depth studies on genetic polymorphisms and susceptibility to rectal cancer are useful for further understanding the pathogenesis of rectal cancer and laying the foundation for exploring primary prevention and effective gene therapy for rectal cancer. Research on apoptosis in rectal cancer is gradually becoming a hot spot in basic and clinical medical research, showing good prospects. Clinically, anal preservation of rectal cancer is a hot spot of patients’ concern. Theoretically speaking, anal preservation is possible for all those who can reach the standard of radical treatment and preserve the anus. It helps to improve the quality of life of patients.