For patients unfortunately suffering from rectal cancer, they are worried about whether their anus will be cut off when they undergo rectal cancer surgery, especially low rectal cancer surgery. Some patients and their family members think that the removal of the anus will seriously affect their postoperative life, so they are reluctant to undergo anal cutting surgery. The lives of many rectal cancer patients are also threatened because of this concern. So what factors do doctors need to consider when choosing the option of rectal cancer surgery? Under what circumstances is anal preservation surgery applicable? We all know that surgery, radiotherapy and chemotherapy are the three main methods in cancer treatment. For rectal cancer, surgery is a good way to cure it. If the stage of rectal cancer is II or before, about 80% of the patients can be cured. However, if it reaches stage III, the chance drops to about 40-60%. Surgery alone may not be enough to achieve complete cure for patients with intermediate to advanced stage, and adjuvant radiation therapy and medication are needed. If the treatment is not standardized, it can cause irreparable damage to patients. At present, there is a relatively standard set of treatment principles and norms for colorectal cancer treatment. Meanwhile, updated clinical guidelines for colorectal cancer are released annually internationally or domestically. However, colorectal cancer is a highly heterogeneous disease and each patient’s condition may be different. Therefore, individualized treatment plans can be formulated to enable patients to receive the most appropriate treatment and avoid unnecessary overtreatment to improve the quality of life. Pre-operative evaluation What is the case for anal preservation surgery? Whether rectal cancer can be cured depends on the stage of tumor development at the time of diagnosis, the patient’s physical condition, and the correct choice of treatment. Whether rectal cancer can be treated with anal preservation surgery also depends on the patient’s specific conditions, including the patient’s general condition, the degree of tumor differentiation, the extent of infiltration and metastasis, and the distance of the lower edge of the tumor from the dentate line. The attending surgeon will make a good assessment before surgery to determine whether the patient is suitable for anus-preserving surgery. This requires a comprehensive examination by the doctor, which integrates local factors (distance of cancer from anus, malignancy of tumor, sphincter function and systemic conditions (presence of anemia, cardiovascular disease, liver and kidney function, presence of metastasis, etc.) to determine the initial general surgical plan, and the final decision on the surgical method is made during surgery rather than before surgery, because the results of physical examination of patients often differ from the actual situation. Of course, in principle, rectal cancer surgery is based on the premise of radical treatment, requiring the distal cut edge to be more than 50px from the lower edge of the cancer. In general, anus-preserving surgery is applicable to rectal cancer above 125px from the dentate line, and there are also reports of anus-preserving surgery for lower rectal cancer at a closer distance. However, anus-preserving surgery has been carried out in large numbers, and now the rate of anus-preserving surgery for rectal cancer has reached 70%, some even 90%, and the 5-year survival rate is greater than that without anus-preserving surgery (Miles). No matter what disease is treated, the premise is to preserve life, and on this basis, the organs and functions of the patient’s body should be preserved as much as possible to improve the quality of life. Of course, it is best to perform anus-preserving surgery because it not only preserves the patient’s original physiological functions, but also helps the patient to face life with more confidence, which is good for the recovery of the body. However, doctors also remind us that surgery should still focus on the patient’s survival, and even if the surgery cannot preserve the anus, patients do not have to be too worried and disappointed. Because with the improvement of stoma irrigation equipment and stoma bag technology, the quality of life of stoma patients has also been greatly improved, and now even patients who perform anal incision surgery can work and live like normal people.