Postoperative recurrence of rectal cancer has always been a major problem for surgeons and an important factor affecting the average postoperative mortality and survival rate. We usually discuss the recurrence of rectal cancer mainly refers to the tumor recurrence in the local area of surgical operation or nearby lymphatic flow area as well as adjacent organs, therefore, the recurrence of rectal cancer is usually divided into two types: intra-intestinal recurrence and extra-intestinal recurrence. For distant metastases such as liver and lung, we will not discuss them here. The factors leading to the recurrence of rectal cancer are: the stage of tumor, biological characteristics, surgeon’s factors, the use of comprehensive treatment after surgery, therapeutic response and immune function status, etc. From the analysis of the above factors, the most important factor that can be controlled is that the surgical operator should be more strict in the specification of surgical operation, the selection of surgical modality and the use of comprehensive treatment for high-risk patients. In terms of the choice of surgical modality, for low to medium rectal cancer with late staging, ulcerative growth, poor biological characteristics such as hypofractionated or mucinous adenocarcinoma and intraoperative judgment of vascular invasion, extensive radical resection should be generally adopted, i.e., combined abdominoperineal resection should be chosen, at this time, special caution should be exercised if anastomotic anus-preserving surgery is chosen, even if anterior resection is chosen, it should be performed on the basis of securing adequate distal margins, and distal The distal margin should be at least 3.5 cm or more. In addition, special attention should be paid to the adoption of appropriate extended radical and debridement techniques. During surgery, more emphasis should be placed on the adoption of tumor-free techniques, reasonable and standardized regional lymph node dissection techniques, etc. for high-risk patients. For example, the metastasis rate of lateral lymph nodes in rectal cancer below the peritoneal reflex line is about 10%-20%, and the general rectal cancer resection and Miles procedure may cause metastatic lymph nodes to remain in about 10% of cases, leaving a hidden danger for regional lymph node recurrence after surgery. Of course, here we should especially emphasize the strict adherence to the technical standards of total rectal mesenteric resection during the surgical operation. Pre- and postoperative radiotherapy for rectal cancer can reduce the postoperative recurrence rate, but it can also increase some complications, so some scholars suggest that radiotherapy should only be used selectively for high-risk groups prone to recurrence after surgery. The results of multicenter studies have clearly confirmed that preoperative radiotherapy for rectal cancer can reduce the local recurrence rate. In addition, it is important to emphasize that the presence or absence of cancer cells in the resected tumor margin is significantly associated with postoperative recurrence of rectal cancer (10% recurrence rate in the group without cancer cells in the margin and 78% recurrence rate in the group with cancer cells in the margin). Therefore, surgeons should avoid performing palliative resection when radical resection of rectal cancer is possible.