Recently, many patients have come to our clinic seeking ultra-low anal preservation surgery for rectal cancer, which can be said to be inseparable from our emphasis on ultra-low anal preservation for rectal cancer, academic promotion, training and patient recognition. First of all, we thank you for your trust and support, but I would like to say that ultra-low anal preservation surgery for rectal cancer may only be a skill, which is only a small part of the rectal cancer treatment process and requires efforts from many aspects in order to make rectal cancer patients truly benefit from it. 1. Whether rectal cancer can preserve anus not only depends on the distance of tumor from anal verge, MDT assessment is more important As we all know, the closer the rectal tumor is to the anal verge, the more difficult the operation is and the less chance to preserve anus, but with the progress of technical platforms such as laparoscopy and ultrasonic knife and the development of new technologies (such as taTME, ISR), the distance of tumor according to the anal verge is not an absolute limiting factor for whether anus can be preserved, in our In our team, tumor distance within 5cm from the anal verge can be used to achieve ultra-low level anal preservation for patients. In fact, it is more important to evaluate the staging of rectal tumors, especially high-resolution magnetic resonance imaging (MRI) and rectal ultrasound, to assess the depth of tumor invasion in the rectal mesentery, the relationship with the external anal sphincter and anal levator muscle, and the relationship with the internal and external sphincter gaps, so that we can assess which patients can be safely operated with super-low anal preservation and which patients will definitely be affected by direct surgery. The MRI assessment of staging can be used to evaluate which patients can be safely treated with super-low anus-preserving surgery, which patients will definitely have residual tumor if operated directly, and which patients may have a high risk of recurrence despite the possibility of surgery, and thus some patients may need to be treated with pre-surgical radiotherapy to regress the tumor, thus increasing the resectability of the tumor and reducing the recurrence rate. Therefore, super low anal preservation for rectal cancer is not only a reflection of a doctor’s technical ability, but more importantly, it requires a multidisciplinary integrated diagnosis and treatment team (MDT) including imaging, radiotherapy, medical oncology and ultrasound to support and escort. 2. There may be abnormal stool control after ultra-low anus preservation surgery for rectal cancer, which needs to be accepted rationally 60%~90% of patients will have different degrees of abnormal defecation after rectal cancer surgery, usually the lower the tumor location and the lower the anastomosis location, the higher the incidence of abnormal defecation and the more serious the symptoms, but most patients will have significantly reduced the number of defecation in about 1 year, and as long as 2 years. In a few patients, the symptoms are always more severe and seriously affect the quality of life, and colostomy surgery may eventually be chosen. Therefore, after a rectal cancer patient has successfully undergone ultra-low anal preservation surgery, he still needs to rationally accept the recovery process of postoperative anal function and perform anal function exercises under the guidance of doctors. For elderly people older than 75 years old and rectal cancer patients with poor preoperative bowel control ability, receiving ultra-low anal preservation surgery should be carefully chosen, and the quality of life is not necessarily better than stoma surgery (stoma bowel clearance can be artificially control). Therefore, whether to perform ultra-low anal preservation for rectal cancer patients, as a doctor who has mastered the technique of ultra-low anal preservation needs to consider from many aspects, including: the distance of the tumor from the anal verge, the preoperative MRI stage of the tumor, the patient’s age, the usual bowel control ability and the patient’s will, etc. How to better achieve anal preservation, it is not enough to rely on a single surgeon, but more important is a multidisciplinary assessment and treatment team. In order to achieve better anal preservation, it is not enough to rely on a single surgeon, but a multidisciplinary assessment and treatment team is needed to truly benefit the patient from anal preservation.