In the past 30 years, the incidence of colorectal cancer in China has been increasing year by year, and rectal cancer accounts for about 85% of colorectal cancer. Rectal cancer has become one of the most common malignant tumors. For rectal cancer in higher sites, if the disease is not too advanced, the anus can be preserved in general. However, for low and middle-grade rectal cancer, especially low rectal cancer, whether the anus can be preserved during surgery is the main concern of the patients and their families, and is also an issue that surgeons need to consider seriously. If the anus cannot be preserved, an artificial anus should be made in the abdomen, commonly known as fistula, which means hanging a fecal bag in the abdomen to defecate from the abdomen. Patients with rectal cancer have serious resistance to this, mainly because of the inconvenience of living with an artificial anus in the abdomen, the decrease in quality of life, and psychological damage, such as fear that people around them will discriminate against them, unwilling to go out of the house and participate in social activities. Doctors will consider more, not only to respect patients’ requirements, but also to strive for the eradication of tumor in order to achieve the best treatment effect. It should be pointed out that a well-made artificial anus is not as good as a natural one, so the patient’s wishes should be sympathized with and the anus should be preserved as much as possible without violating medical principles. However, it should also be emphasized that it is actually worse to preserve the natural anal form without preserving its original anal function; if the reluctantly preserved anus has no stool control function and keeps flowing stool all day long, it is equivalent to a kind of perineal artificial anus, which is not as convenient as the abdominal artificial anus for postoperative care, as the abdominal artificial anus can be attached to a stool bag to collect stool, which is simple and hygienic and protects the skin from The abdominal artificial anus can be attached to a stool bag to collect stool, which is simple and hygienic and protects the skin from fecal erosion, while the perineal artificial anus cannot do so and complications can occur quickly. As for patients who sacrifice the thoroughness of the surgery and reduce the cure rate in order to preserve the anus, it is more than worth the loss. Therefore, when radical cure and anal preservation cannot be combined, the sensible choice is to put radical cure first, and the abdominal artificial anus should not be seen as a serious defect of radical resection for low rectal cancer. The last thing doctors want to see is that patients give up the surgery when they cannot be convinced, which is tantamount to giving up their chances of survival, which is stifling. However, patients do not have to worry too much. In recent years, with the progress of science and technology, especially the new understanding of biological characteristics of rectal cancer, the development of preoperative radiotherapy, the improvement of surgical instruments, especially double anastomosis, and the improvement of surgeons’ surgical skills, more and more low rectal cancer can be anus-preserving, and most patients who originally had to be fistulized have avoided anal resection. At present, there are several types of anus-preserving surgery for low and middle rectal cancer, especially for low rectal cancer: 1. transabdominal anterior rectal resection, i.e., the classic Dixon procedure, which was originally designed only for tumors above the peritoneal fold, but the application of double anastomoses, especially the curved cutting sutures, has extended the application of this procedure to anus-preserving surgery for low and middle rectal cancer. 2. 2.Park procedure (transanal coloanal anastomosis), which is suitable for those patients who cannot use double anastomosis, preserves the internal and external sphincter of the anus, and the anastomosis is located at the upper edge of the anal canal or the dentate line. 3.Inter sphincter rectal resection (ISR), which was originally designed for the anal resection of patients with inflammatory bowel disease who underwent total colon or rectal resection, only the internal sphincter of the rectum and anal canal is removed, and the external sphincter and surrounding tissues are preserved, so as to avoid long-term non-healing of the perineal incision. It is also used for the anal preservation treatment of middle and low rectal cancer. 4.Trans-anterior perineal ultra-low rectal resection (APPEAR procedure), which was first reported by Prof. Williams in May 2008, has the same trans-abdominal division as ordinary anterior resection, and the perineal operation is entered by the anterior perineal pathway, and the pelvic floor muscle is severed under direct vision, so that the lower end of the pelvic floor muscle and puborectal muscle, which could not be revealed by previous operations, can be freed with an average length of about 3 cm. The rectum is removed from the pelvis through an anterior perineal incision, and the rectal stump or anal canal is anastomosed to the proximal colon using a double anastomosis technique outside the body. Theoretically, this procedure seems to be able to achieve the ultimate anal preservation, but postoperative problems such as incisional infection and anastomotic leakage have yet to be tested. Mason’s operation, which is a low rectal tumor resection via the anal sphincter route (Mason’s operation), is in principle only indicated for early rectal cancer (except for palliative resection). 6.Other procedures include bacon operation, turnbull operation, local resection of tumor, TEM operation (transanal endoscopic minimally invasive surgery) and so on. These procedures need to be decided at the discretion of the doctor according to the specific conditions of the patient. Since the indications or indications for these procedures are very specialized, it is very difficult for the general public or even junior doctors to master them. Patients and their families should not interfere with the doctor’s choice of surgical procedure because they have little or no knowledge of it.