1. The importance of preoperative rectovaginal finger diagnosis for rectal cancer. Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital, China The general types of rectal cancer surgery are divided into anus-preserving surgery and non-anus-preserving surgery. Whether anal preservation is possible or not is mainly based on the distance between the lower edge of the tumor and the anus. In principle, if the tumor is 5 cm away from the anus, it has the possibility of anus preservation. With the improvement of people’s demand for quality of life and the application of modern high-tech products, the tumor is 4 centimeters away from the anus, which also has the chance of anal preservation. Therefore, the distance of tumor from anus is crucial. Theoretically, the distance of effective anal preservation is the distance of tumor from the dentate line of anus, not the distance from the anal opening. The distance of the tumor from the anus as reported by many clinical colonoscopies is mostly the distance between the tumor and the skin margin of the anal opening rather than the distance of the tumor from the dentate line of the anus. For example, a colonoscopy reports the tumor to be 5-6 cm from the anus, but the actual effective anus preservation length, i.e. the distance of the tumor from the dentate line of the anus, may be 3 cm. In some cases, colonoscopy reports that the tumor is 8 cm from the anus, but in fact the tumor is only 2 cm from the dentate line. 8 cm from the dentate line can preserve the anus, but 2 cm is less likely to preserve the anus (unless the tumor is small and shallowly invasive), which is a big difference between the two surgical approaches. Therefore, rectal diagnosis must be performed before surgery to confirm the distance between the tumor and the anal dentate line and to decide the surgical method. Vaginal examination is also the most reliable way to determine whether the posterior wall of vagina is invaded. 2. Preoperative rectal and vaginal examination is also an important detection target to determine whether large pelvic tumor or recurrent tumor can be resected or the preoperative surgical method. Many pelvic tumors are large in size, and pelvic CT indicates that the large size of tumor is closely related to bladder (uterus), rectum and prostate, so rectal and vaginal examinations are relatively important to determine whether surgery can be performed and what kind of surgery can be performed. In men, 5cm of normal anterior rectal wall on rectal palpation indicates that the bladder triangle can be preserved, that is, the bladder can be preserved, and it also indicates that the pelvic floor is empty and there is space for separation and access. In women, no matter how large the tumor is, as long as the anterior vaginal wall is normal, it indicates that the bladder triangle is not invaded and the possibility of preserving the bladder is high. For some patients, the ability to preserve the bladder (albeit a small one) is indicative of an improved quality of life. The ability to preserve the bladder indicates that the whole pelvic organs do not have to be removed, and the surgical trauma and difficulty will be much less. Clinical practice confirms that despite the large pelvic tumor, if the rectal and vaginal fingers are normal, the tumor has a high chance of removal. Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital, China 3. The importance of postoperative rectal examination. Postoperative rectal finger diagnosis has the following advantages: (1) clarify whether there is bleeding from rectal anastomosis. Rectal anastomosis bleeding is one of the common complications after rectal cancer surgery. Because anastomotic bleeding is mostly bleeding from small arteries on the intestinal wall, just after surgery, most of the blood accumulates in the intestinal cavity, which is not easy to detect, and when it accumulates to a certain extent, it can only be discharged from the anus, therefore, relatively many patients show it only in the ward after surgery, and blood clots are discharged from the anus. Bleeding from small arteries in the intestinal wall does not close on its own and must be treated surgically. After rectal anastomosis, you cannot only observe the integrity of the anastomotic ring on the anastomosis, but also observe to perform rectal palpation to know whether there is fresh blood clot in the intestine. If there is fresh blood clot in the intestine, most of them have anastomotic bleeding and need to be treated. Do it in time, early detection, early treatment, and facilitate the patient’s recovery. (2) Understand the integrity of the anastomosis. Postoperatively, the operator performs rectal palpation to understand the integrity of the anastomosis and to understand the development of the disease. Exclude the related symptoms caused by anastomotic leak such as abdominal distension, abdominal pain, fever, etc. Rectal finger diagnosis is relatively important for the treatment of rectal cancer patients, and the surgeon should be diligent in hand and brain.