At present, the means to obtain a cure for rectal cancer is still surgery. Admittedly, there may be some chemotherapy and radiotherapy before and after surgery depending on the condition, but these are all adjuvant treatments. As far as many patients I have contacted, whether or not rectal cancer surgery can preserve the anus may seem more important than its survival time! This is an understandable reason and feeling as a doctor: normal bowel function and habits are only that important at this time! How hard it is to say goodbye forever to the anus, which usually gets less attention or is generally avoided! Rectal cancer is a cancer that occurs within 15cm from the anus. Because of the surgical treatment, doctors often divide it into upper, middle and lower segments, and the preservation of the anus is mainly the lower segment of rectal cancer. In other words, tumors that are more than 5cm from the anal verge can be preserved from the general situation. However, as China is so large and inconsistent in development, this may not be true in some places, and combined abdominoperineal resection (cutting off the anus) is still the mainstream surgical procedure for rectal cancer in some places, and the so-called places I have seen here even include some prefecture-level cities less than 200 km from Guangzhou! With today’s exceptionally advanced information and transportation, there are still cases where the anus is removed when it could have been preserved, so I can’t tell if it’s the patient’s or the doctor’s sorrow! Of course, in today’s medical environment and doctor-patient relationship, perhaps the starting points and initial intentions of those doctors are understandable, such as wanting to increase the safety of resection and improve the effectiveness of radical treatment. What about tumors under 5cm? Is resection of the anus an absolute indication? Probably many colorectal surgeons have performed anus-preserving surgery for low rectal cancer, and preserving the anus is not only the desire of patients with low rectal cancer, it is also the desire of colorectal surgeons! It is also the desire of colorectal surgeons! In fact, for the issue of anal preservation, it cannot be expanded, if the muscle of the anus is invaded by the tumor, if the anus is preserved it may harm the patient, excluding the tumor recurrence rather, because a non-functional anus in life in may be more very culinary and care. Nowadays, the indications for anal preservation are very strict, which also ensures that doctors cannot abuse this view and technique, but we cannot deny that after generations of efforts, people are cautiously moving the standard point of anal preservation down little by little! Because the safety of 1 cm distance from the distal margin has been confirmed by most practices, it is possible to expect that in the future, anal preservation is as fundamental a treatment principle as radical treatment for low rectal cancer (including low rectal cancer)! At present, there are several types of anus-preserving surgery for low and middle rectal cancers, especially low rectal cancers: 1. transabdominal anterior rectal resection, at present, total rectal mesorectal resection with double anastomosis, especially the application of curved cutting sutures, so that this procedure is also extended to anus-preserving surgery for low and middle rectal cancers. 2. 2.Park procedure (transanal coloanal anastomosis), this method is more suitable for those patients who cannot use double anastomosis, the procedure 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 to be used for anal resection in patients with inflammatory bowel disease who underwent total colon or rectal resection, only the internal sphincter of the rectum and anal canal is removed, while the external sphincter and surrounding tissues are preserved 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. This method was reported in 2008, and its transabdominal division is the same as the common anterior perineal 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 rectum, which is wrapped by the pelvic floor muscle and puborectalis muscle, can be freed with an average length of about 3 cm, and the freed rectum is dragged out from the pelvic cavity by the anterior perineal incision. The colorectum is dragged out of 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. 5, local resection of rectal cancer, (such as Mason surgery), it is a low rectal tumor resection via the anal sphincter route, in principle, only early rectal cancer has indications (except for palliative line resection). The specific method of anal preservation must be determined by the doctor according to the patient’s specific situation. Because the indications of these surgeries are very specialized, it is difficult for the general public or even non-professional doctors to grasp them. Patients and their families should not interfere with the doctor’s choice of procedure because of a half-understanding, but must carefully and fully communicate with the doctor.