If the pathology shows cancer after rectal ESD surgery, if ESD surgery has not cut the diseased tissues cleanly, additional surgery is needed, but not if the diseased tissues have been completely resected. 1. Additional surgery is needed: postoperative pathology suggests cancer, early detection and early treatment are needed, the tumor invades to the muscle layer, ESD surgery can not cut cleanly, otherwise perforation of intestinal wall will easily occur, so it is necessary to consider additional surgery at this time, and the specific surgical plan needs to be decided by the surgeon according to the patient’s condition and the scope of the tumor. 2. No additional surgery: rectal ESD surgery is endoscopic submucosal dissection, most of the diseased tissues can be completely resected, and there is no need for additional surgery even if the postoperative pathology shows cancerous lesions. However, postoperative pelvic CT or colonoscopy should be repeated once every 1~3 months, and the next treatment plan should be formulated according to the results of the follow-up examination. If the postoperative pathology of rectal ESD suggests cancer, it is also necessary to know whether there is invasion of the tumor, whether there is metastasis, immunohistochemistry, etc., in order to formulate the follow-up specific treatment plan, and follow the instructions.