Anal preservation methods for anal canal adenocarcinoma include local excision, radiotherapy and radiotherapy combined with chemotherapy. A small number of anal canal adenocarcinomas can undergo local excision for anal preservation, and the indications include tumor less than 2cm, superficial lesion, good activity, and no metastasis. The scope of local excision includes 2~2.5cm of the tumor margin, and part of the muscle is excised if necessary. Radiotherapy mainly utilizes cobalt to irradiate, and if inguinal lymph node metastasis occurs in anal canal adenocarcinoma, radiotherapy can be carried out first, followed by lymph node dissection surgery. Radiotherapy has a 90% control rate for small tumors. The program of radiotherapy combined with chemotherapy can reduce the side effects brought by radiotherapy and also play a sensitizing role for radiotherapy. At present, radiotherapy combined with chemotherapy is considered to be the preferred method of treating anal canal cancer, and the tumor regression rate after the combined treatment can reach more than 80%. The choice of treatment modality for anal canal adenocarcinoma with anal preservation should be based on the assessment of specific conditions and under the guidance of physician.