Whether or not to preserve anus after rectal cancer surgery is also an important reason why many patients are afraid of talking about surgery. Recently, the news of Nie Weiping’s successful surgery for rectal cancer seems to bring a ray of hope to patients in deep fear – pre-operative radiotherapy makes anal preservation possible. According to reports, Nie Weiping underwent minimally invasive surgery and doctors successfully removed all of his tumor lesions. This means that the “chess saint” did not have to undergo a combined transabdominal perineal resection, as many bowel cancer patients do, in order to achieve a radical cure, and then lose normal bowel function and have to rely on an artificial fistula to replace the anal function. The important reason why Nie Weiping preserved his anus is that he received preoperative radiotherapy, and then underwent surgery after the tumor volume was relatively reduced and the environment near the tumor was locally cleared, and after the surgery, he chose adjuvant radiotherapy according to the situation. For rectal cancer patients, it is a difficult choice whether to remove the tumor or preserve the anus by radical surgery, mainly because the rectal tumor is relatively close to the anus. Especially when the tumor is within 7 cm from the anal verge, the surgical resection will include the lower part of the sigmoid colon and its mesentery and all of the rectum, the lymph nodes around the inferior mesenteric artery, the anal levator muscle, the fat in the sciatic rectal fossa, the anal canal and the surrounding skin of about 5 cm in diameter, and all of the anal sphincter. After surgery, the surgeon makes a permanent artificial anus in the patient’s lower left abdomen – although it allows for partial function of the anus, it is also indisputable that the patient’s quality of life changes dramatically as a result. For this reason, the medical community has done a lot of research in recent years and concluded that two weeks of preoperative radiotherapy for rectal cancer can significantly improve the chances of preserving the anus. The so-called preoperative radiotherapy, also known as neoadjuvant therapy, is to irradiate the tumor site with radiation to gradually shrink the lesion and expand the distance between it and the anus, thus improving the rate of anal preservation. In the past, due to its limitation, traditional radiotherapy would damage the rectum, which is a kind of cavity organ, thus rectal cancer is a forbidden area for radiotherapy in clinical practice. According to the introduction of Xia Tingyi, the president of the Cancer Hospital of Air Force General Hospital, with the birth and maturity of precise radiotherapy technology, the TOMO radiotherapy system, for example, has its own spiral CT to check the irradiated area before each treatment to ensure that there will not be any deviation in the treatment process; in addition, the technology enables high-dose irradiation to be concentrated on the focal area, so that the surrounding normal tissues are irradiated at the lowest dose. Thus, radiotherapy in the era of “precision” not only does not cause major side effects to rectal cancer patients, but also improves the chance of anal preservation after surgery. Another interesting trend is that preoperative radiotherapy is expected to significantly improve the survival rate of rectal cancer patients and reduce the chance of recurrence. Researchers at Leiden University Medical Center in the Netherlands randomly selected more than 1,800 rectal cancer patients for resection and resection plus preoperative radiotherapy, and found that the tumor recurrence rate was 2.4% for surgery combined with preoperative radiotherapy, while the recurrence rate was 8.2% for surgery only. This is because preoperative radiotherapy can prevent the spread of cancer cells during surgery, reduce local and pelvic implantation, make the tumor decrease, expand the indications for surgery, loosen cancerous adhesions and improve the surgical resection rate. It is generally believed that preoperative radiotherapy for rectal cancer can increase the survival rate of patients by 10%-15% and reduce the local recurrence rate by 10%-15%.