Abstract Jacobs et al. reported the world’s first laparoscopic-assisted colectomy in 1991, and since then laparoscopic colorectal cancer surgery has been performed worldwide, but there have been many controversies since laparoscopic surgery for rectal cancer was performed. Can laparoscopic rectal cancer surgery achieve the same resection effect as open surgery? In other words, can laparoscopic rectal cancer surgery achieve the desired results in terms of the integrity of rectal mesenteric resection, the rate of positive circumferential margins, and the total number of lymph nodes detected? Does laparoscopic rectal cancer surgery increase surgical complications? Will the survival and recurrence of laparoscopic rectal cancer surgery be consistent with open surgery? Will obesity and a history of abdominal surgery affect the performance of laparoscopic surgery? There are many questions such as these, and we will answer them one by one below. 1. Can laparoscopic rectal cancer surgery achieve the same resection results as open surgery? After Heald et al. introduced the concept of rectal mesorectal excision in 1982, total mesorectal excision TME has become the “gold standard” of rectal cancer treatment after more than 30 years of clinical practice. The results of a multicenter, large sample study conducted by the Colorectal Cancer Laparoscopic or Open Resection Study Group (COLOR II), which included 1103 patients in 30 hospitals in 8 countries, randomly divided into 364 patients in the open group and 739 patients in the laparoscopic group, showed no statistically significant differences in the completeness of TME laparoscopic resection, the rate of positive circumferential margins, and the total number of lymph nodes detected between the two groups. A similar study was conducted in Korea in 2010 in The Lancet on COREAN (Comparison of Open versus laparoscopic surgery for mid and low REctal cancer After Neoadjuvant chemoradiotherapy), in which 7 physicians from 3 centers participated, also showed no statistically significant differences in TME tethered resection completeness, peri-annular margin positivity, and total lymph node detection. These large sample studies demonstrate that laparoscopic rectal cancer surgery is fully capable of achieving the same resection results as open surgery. Does laparoscopic surgery for rectal cancer increase surgical complications? The COREAN study in Korea also followed up the autonomic nerve injury in the open and laparoscopic groups at 3 months after surgery and showed that the urinary dysfunction in the laparoscopic group was significantly less than that in the open group, and there was no difference in sexual dysfunction between the two groups. Regarding complications in patients who underwent laparoscopic rectal cancer surgery after neoadjuvant radiotherapy, the results of Valenti et al. showed that the differences in wound infection, abdominal abscess, anastomotic fistula, postoperative bleeding, and urinary complications were not statistically significant between the two groups compared with the open group. In addition, patients in the laparoscopic group also had the advantages of less bleeding, less postoperative pain, faster recovery of bowel function, and shorter hospital stay compared with the open group because of less trauma. 3. Will the survival and recurrence of laparoscopic rectal cancer surgery be consistent with open surgery? Data from the previously published COREAN in The Lancet in 2014 [6] and from the previously published COLOR II in The New England Journal of Medicine in 2015 were updated, and these studies followed overall survival, tumor-free survival, and local recurrence rates of patients in the open versus laparoscopic groups over 3 years and showed no statistically significant differences. The New England Journal of Medicine also published in 2015 a global multicenter, large sample study conducted by the Vrije University Amsterdam Medical Center, an international trial conducted at 30 hospitals, in which they studied tumor recurrence rates, disease-free survival, and overall survival in the pelvic and perineal regions at 3 years postoperatively in patients in the open versus laparoscopic groups In the trial, 1044 patients (699 in the laparoscopic group and 345 in the open group) were enrolled and randomly assigned to have one of the procedures if they had isolated rectal adenocarcinoma within 15 cm of the anal verge. The results of the study showed that the local recurrence, disease-free survival and overall survival rates of laparoscopic surgery in patients with rectal cancer were similar to those of open surgery. 4. Does obesity and a history of abdominal surgery affect the performance of laparoscopic surgery? In the 2009 Journal of the American College of Surgeons JACS and the 2012 Annals of Surgery, it was suggested that patients with no history of abdominal surgery and no obesity should be selected at the beginning of laparoscopic surgery because patients with obesity and a history of abdominal surgery often have various comorbidities that increase perioperative complications and mortality, poor intraoperative visualization, and greater anatomical exposure. Karahasanoglu et al. reported no significant differences in complication rates among the non-obese, overweight and obese groups, and no differences in operative time, intraoperative bleeding and postoperative recovery among the three groups, which has shown that laparoscopic rectal cancer surgery in overweight and obese patients does not increase the incidence of operative complications and the rate of intermediate open abdomen, and the radical tumor and long-term survival outcomes are similar to those of the non-obese group and are therefore safe and feasible. The safety of laparoscopic rectal cancer surgery has also been recognized internationally. In the 2016V1 edition of the National Comprehensive Cancer Network (NCCN) guidelines for rectal cancer, in the section on principles of transabdominal radical surgery, a new section was added, “For patients with rectal cancer, laparoscopic radical surgery is recommended. In the 2016 V1 edition of the National Cancer Network (NCCN) guidelines for rectal cancer, a new section on “laparoscopic radical surgery for patients with rectal cancer” has been added to the section on principles of transabdominal radical surgery, a leap from the “recommended” level to the “performed” level. This is a direct indication that the authoritative research institutions in the medical field have affirmed the therapeutic effect of laparoscopic radical rectal cancer treatment. So, do you get it? Both pilot studies and guidelines from authoritative institutions show that laparoscopic radical rectal cancer treatment is effective and reliable, so when choosing a surgical treatment, there is no need to doubt its safety anymore and listen to your treating doctor to choose the most suitable treatment and surgical plan.