Mr. Zhang found a 4 cm diameter cauliflower-like tumor in the rectum about 3 cm from the anus during the anal finger examination of his health checkup, and the pathology confirmed that it was a malignant adenocarcinoma. After careful physical examination and analysis of Mr. Zhang’s condition, combined with the fact that the tumor was located in the anterior rectal wall and the local infiltration was deeper, Mr. Zhang was told that according to the traditional surgical principles, malignant tumors below 5 cm from the anus need to be removed from the anus under the principle of radical treatment. After 4 hours of intense surgery, the operation was successful. The diseased rectum was resected under direct vision by exposing the anterior rectal wall in the curved perineal incision, and the recto-anal anastomosis was performed in one stage to preserve the anus. The “APPEAR” surgery (transabdominal anterior perineal ultra-low rectal cancer extreme anus-preserving surgery) is a new international surgical procedure that has started in recent years, which requires a high level of operating physicians and is especially suitable for progressive tumors located in the low anterior rectal wall. In recent years, the incidence of colorectal cancer is increasing, and about 50% of the patients are rectal tumors. The development of “APPEAR” surgery has brought good news and improved the quality of life for those rectal cancer patients who cannot preserve their anus.