Enterostomy does not reduce the incidence of anastomotic fistula in low-grade rectal cancer undergoing low anterior resection. However, once an anastomotic fistula occurs, patients with an enterostomy do not experience serious complications. It reduces the risk of patients, so enterostomy is recommended for low anastomosis or ultra-low anastomosis for safety. Especially for low rectal cancer treated with neoadjuvant radiotherapy, colostomy or ileostomy should be performed at the same time to reduce the serious complications caused by anastomotic fistula. Because the healing ability of the stump rectum will be affected after neoadjuvant radiotherapy. The author mostly chooses ileostomy, which will be much easier to close the colostomy in the second surgery. Anal preservation surgery for low rectal cancer has been adopted by more and more surgeons, effectively preserving the sphincter function of the anus and improving the patient’s quality of life. Those surgical modality changes that focus on anatomical and pathophysiological studies can significantly improve the rate of anus preservation in low rectal cancer, while modifications specific to the surgical modality often have variable results and are difficult to produce significant differences in outcomes.