In the past two decades, one of the greatest advances in the surgical treatment of rectal cancer has been the theoretical and practical confirmation of the rationality and possibility of anus-preserving surgery for middle and lower rectal cancer. Due to the improvement and development of surgical techniques and surgical instruments, the proportion of anal preservation in rectal cancer surgery has been greatly improved. However, the anal preservation surgery for low rectal cancer is still one of the difficulties and hot spots in surgical treatment at present. Due to its special anatomical location, special lymphatic reflux pathway and special adjacent relationship with genitourinary organs, anal preservation surgery differs from upper rectal cancer in terms of surgical indications and technical difficulties. The use of the double anastomosis clutch has been largely discarded. Although the use of double anastomosis has created more opportunities for anal preservation in patients with low rectal cancer, the current design of double anastomosis has not yet reached the level of perfection, and it is difficult to cut the closed rectum in the plane of the pelvic floor muscle in men or patients with pelvic stenosis and obesity. Therefore, it is difficult for patients with low rectal cancer 5-6 cm from the anal verge to achieve the purpose of anus preservation with the help of double anastomosis. In recent years, the surgical treatment of low-grade rectal cancer has been carried out with such anus-preserving surgeries as Parks surgery (transabdominal rectal cancer resection and transanal colorectal anastomosis) and trans-sphincter interval rectal cancer resection. However, the medium- and long-term results show that these two procedures still cannot solve the two major problems of postoperative anal dysfunction and high local tumor recurrence rate. After surgery, 24% of patients had anal incontinence and 58.8% had a sense of urgency; the local recurrence rate of tumor was 0-30%, with an average of about 10%. In May 2008, Norman S Williams, a surgeon at the Royal London Hospital, reported on this new APPEAR procedure and summarized his initial experience with 14 cases. The abdominal part of this procedure is the same as a normal anterior rectal resection (Dixon procedure), where the rectum is separated to the pelvic floor and then the attending surgeon transfers to the perineum. A raised crescent-shaped incision is made between the scrotum (or vagina) and the anal verge. After incising the skin subcutaneously the rectourethral muscle is separated, and along the rectourethral prostate between the prostate (or posterior vaginal wall) towards the pelvis. The abdominal team physician uses his fingers to lift one side of the rectus pars recti to aid in the separation. The other side is then separated in the same manner. Finally, the anterior rectal wall is separated and rejoined with the pelvic surgery. The freed colorectum is dragged out of the pelvis through an anterior perineal incision. The closure is cut with a closure device outside the body. Using a double anastomosis technique, the rectal stump or anal canal is anastomosed to the proximal colon. Compared with traditional anus-preserving surgery, APPEAR surgery has the following advantages: 1. Preliminary results show that the anal function after APPEAR is better than that of ISR and other anus-preserving surgery.