The greatest pain of low rectal cancer surgery is the diversion, i.e., the removal of the anus at the same time as the removal of rectal cancer, and the patient’s postoperative pseudo-anal defecation through the abdomen; the second is the near and long-term pain caused by the huge trauma to the abdomen and perineum. How to reduce the surgical trauma of rectal cancer patients, improve the anal preservation rate of lower rectal cancer patients, and thus improve the survival quality of rectal cancer patients, has become the direction of colorectal surgeons’ efforts. Minimally invasive surgery is the direction of the development of surgery in the 21st century. The doctors of our gastrointestinal specialty group have been working together to explore and improve the surgical methods of laparoscopic resection of lower rectal cancer and low and ultra-low intrapelvic anastomosis, combining the characteristics of domestic and foreign surgical instruments and the affordability of domestic rectal cancer patients, so that they are closer to China’s national conditions, greatly reducing the cost of surgery and improving the curative effect. Practice shows that the minimally invasive surgery of laparoscopic rectal cancer total mesenteric resection, low and ultra-low anastomosis DST for anus preservation is less traumatic, less bleeding, less painful after surgery, early bed activity and quick recovery. It is safe and effective to carry out this surgery on the basis of solid laparoscopic surgical practice by strictly mastering the surgical indications, which has brought good news to rectal cancer patients, broadened the surgical field of minimally invasive surgery and accelerated the development of minimally invasive surgery in our province. However, the author would like to emphasize that although anal preservation is good, it is not a one-size-fits-all procedure, but requires individualized analysis and customized surgical plan. Surgeons and patients need to be more rational in their understanding of anal preservation. Our team has been performing various types of low and ultra-low anal preservation surgery for many years, and has gained a wealth of experience by applying advanced equipment such as laparoscopy and TEM (transanal lumpectomy), and improving and hybridizing many procedures. However, we have also experienced that for some patients, the blind pursuit of anal preservation is counterproductive. For example, in elderly patients, the anal sphincter is originally relaxed and the bowel is incontinent after anal preservation. There are also a few patients with ultra-low anal preservation who have difficulty defecating. How to make a rational assessment before surgery? A very specialized colorectal surgeon is needed to make a comprehensive assessment, including the patient’s age, gender, sphincter tension, preoperative bowel control function, degree of obesity, tumor site, nature and degree of invasion, imaging stage, response to preoperative treatment, nutritional status, risk of postoperative recurrence, risk of anastomotic leakage, patient’s wishes, etc. A failed anus-preserving surgery has a far worse quality of life than an abdominal wall colostomy. From another perspective, some patients may exaggerate the pain of a stoma. In fact, stoma technology, materials and care have advanced so much that many stoma patients can achieve a good quality of life after a period of adaptation.