Colorectal cancer is one of the most common gastrointestinal malignancies, ranking fourth in incidence worldwide and in China, and in Beijing, its incidence ranks second in men and fourth in women. Rectal cancer accounts for 40%-50% of all colorectal cancers in China, while low and middle rectal cancers account for 60%-70%. In outpatient clinics, rectal cancer patients or their families often ask a question: Can the anus be left in place during surgery? Should we do a fecal pocket? My answer is: we should discuss this question scientifically. First of all, whether the anus can be preserved in rectal cancer patients is related to the distance of the tumor from the anal verge. If the tumor is located more than 6cm from the anal verge, this issue is usually not involved. For tumors within 6 cm from the anal verge, the following aspects usually need to be considered to decide whether the anus can be preserved: First, technical aspects: rectal tumors within 6 cm require high technical skills of surgeons and usually encounter difficulties in surgery, such as: tumor location is too low, patient is fat, pelvis is narrow, and anal preservation and surgery quality will be jointly challenged. At present, a combined transabdominal and transanal surgical route, such as taTME surgery, can achieve ultra-low extreme anus preservation and can precisely ensure the clean lower edge of the tumor. Peking University People’s Hospital is a leader in this field in China and is actively promoting this surgical approach and concept throughout the country, aiming to enable more patients with low rectal cancer to obtain anal preservation and improve their quality of life. However, we need to consider two other things that are more important than anus preservation at the same time. The first is oncology, and the most important thing in treating rectal cancer patients is to provide them with survival benefits and prevent recurrence. For a rectal cancer patient, we first need to conduct a preoperative multidisciplinary assessment (MDT) of the tumor to evaluate the size and depth of infiltration. If the tumor invades the anal raphe, the circumferential cutting edge is involved, and the preoperative stage is T3b or above, we usually need to consider preoperative radiotherapy to downgrade the stage of the tumor and reduce the recurrence rate. At the same time, preoperative radiotherapy will also cause some of the very low tumors to regress and increase the rate of anal preservation. The second important issue that needs to be considered is the function of the anus. A big problem of very low location anal preservation is that in a certain period of time, patients have a lot of stools after surgery, some patients have about 10 stools a day, usually after two years, the number of stools will be reduced. Therefore, if an old man with rectal cancer in his 80s has a flaccid anus accompanied by mobility problems, going to the toilet more than 10 times a day can be imagined to be a great pain, and the quality of life will be extremely poor, in this case, colostomy may be a better choice. If the patient has a high demand for quality of life, is in good health and has a strong will to preserve the anus, he or she may choose to preserve the anus, but a multidisciplinary assessment is needed to ensure oncological safety. And patients must accept the recovery process of postoperative anal function and perform anal function exercise under the guidance of doctors. Therefore, we should face low and middle rectal cancer rationally and preserve anus scientifically.