With the improvement of the living standard of Chinese people, the dietary structure and living habits have changed a lot compared with 20 years ago, but the incidence of colorectal cancer has been increasing year by year. According to the latest data in China, in big cities like Beijing and Shanghai, the incidence of colorectal cancer has occupied the second place in the incidence of malignant tumors, and among them, more than half of the patients have tumors located in the rectum. The anus, also known as the “chrysanthemum” because of its shape, is the most important organ at the end of the human digestive tract, because with it, the human body can control bowel movements independently. But unfortunately, many rectal cancer patients, because the tumor is very close to the anus, in many cases, in order to completely remove the tumor and have to remove the anus together. The disease may be cured, but the patient loses the anus, loses the ability to control bowel movements on his own, and becomes a “stoma man” – stool must be discharged through the “artificial stoma” in the abdomen, and has to wear an ostomy bag for life. The current stoma care kit is very humane, not only is it not easy to detect from the appearance of clothing, but also has no special smell, so that patients with rectal cancer who have lost their anus can integrate into work and life faster and better, and there are even foreign “stoma people” participating in bodybuilding competitions. However, for some patients, the loss of anus means that the quality of life will be affected to a certain extent, and there may be obstacles in work and social life, such as not daring to swim, not daring to go to hot springs, not daring to go to crowded places for fear of others smelling the odor, and even leading to psychological illnesses in severe cases, so that they cannot return to work and family. Therefore, after many rectal cancer patients know that they have the disease, the first concern is whether the disease can be cured, and the second concern is whether the anus can be preserved; and some patients who are particularly concerned even refuse to receive treatment because the anus cannot be preserved. How to successfully preserve the anus? In the novels of Jin Yong warrior, there is the “Sunflower Code” which teaches people the best martial arts skills; in the current clinical medical treatment, there is also the “Chrysanthemum Code” which guides patients to achieve successful anal preservation. Dear patients, if you can follow the following “Chrysanthemum Code”, I believe you are not far from successful “anal preservation”: Chrysanthemum Code No. 1: Calm down, don’t panic, don’t panic, don’t panic. The important thing needs to be repeated three times! Many patients and their families may feel that the moment they learn of the disease, they may feel that the sky is falling, they are at a loss, and they are so anxious that they want to lie down on the operating table immediately and let the doctor remove the tumor. However, when people are panicking, they often lose their normal judgment and make choices that are probably not the best options. The second rule of Chrysanthemum Paulownia: Don’t be in a hurry. As the old saying goes, “the patient is in a hurry to seek medical help”, which often refers to this kind of situation, the patient may not only visit the best specialized hospital for disease treatment, but may even be cheated by some charlatan doctors, and the patient will be empty. At present, tumors have been included in the category of “chronic diseases”. For rectal cancer, the process of developing from benign intestinal polyps into rectal cancer takes several years or even a decade, except for a few early rectal cancers, most rectal cancer treatment cycles need to last about half a year, so surgery or other treatment a week or two earlier or later does not have much impact on the development of the disease. On the contrary, it is not uncommon to see treatment failures due to anxious surgery without the best comprehensive treatment plan. For example, anxious surgery results in intraoperative discovery of multiple metastases in the liver and abdominal cavity; anxious surgery without preoperative radiotherapy results in unclear cut margins and tumor recurrence soon after surgery. Although the surgery was done a week or two earlier or a month or two earlier, the hope of cure was lost and the chance to live happily with family and friends for decades was lost! Such examples are endless! The third article of Chrysanthemum Paulownia: Find a professional integrated treatment team. Although surgery plays an important role in the treatment of tumor, the role of radiotherapy and chemotherapy is essential to successfully preserve anus and prevent tumor recurrence and metastasis. Although there are some experienced surgeons who can judge whether anus preservation is possible just by anal diagnosis, in most cases, if a surgeon judges that a patient must not be able to preserve anus without mentioning radiotherapy as a treatment, the patient must consult the radiotherapist again. It is likely that after radiotherapy for rectal cancer, the tumor regresses significantly, changing from unresectable to radically resectable, from unresectable to anus-preserving to anus-preserving, and even in cases where radiotherapy is particularly effective, surgical resection is no longer necessary, not only successfully preserving the anus, but also avoiding the pain caused by the knife of surgery. Article 4 of Chrysanthemum Paulownia: Improve relevant examinations, clarify disease stage and formulate the best comprehensive treatment plan. The process of treating rectal cancer is a protracted war, and surgery, radiotherapy and chemotherapy are like land, sea and air forces. In order to win the war, we need to fully understand the enemy and us, consider the whole situation, make a comprehensive battle plan, and use the available treatment means comprehensively; otherwise, the victory of one local battle or even one battle can not bring victory of the whole war. Successful surgery is not equal to successful treatment. Some patients were not treated comprehensively after getting sick, but were quickly hospitalized for surgery to remove the tumor, but the tumor recurred and metastasized a few months later; this is like Japan’s successful attack on Pearl Harbor, but ended up with defeat and surrender. Therefore, before treatment, rectal cancer patients should complete comprehensive colonoscopy, thoracoabdominopelvic enhancement CT, rectal MRI and other examinations to understand whether the tumor has metastasis and the early or late local condition, so that the corresponding plan can be formulated for each patient’s situation: for example, patients who have already had liver or lung metastasis may have to do chemotherapy first and then decide whether to operate; for patients who do not have liver and lung metastasis, but the tumor is locally For patients who do not have liver or lung metastasis, but the tumor is relatively late and has already invaded the intestinal wall or peri-intestinal lymph node metastasis, they may need radiotherapy first and then surgery; even for early stage patients, the tumor has not yet invaded the intestinal wall or lymph node metastasis, but if the tumor invades the internal orifice of the anal canal or the dentate line, in order to improve the chance of anal preservation, radiotherapy must be done first and then surgery; and if the tumor is particularly early, it does not even need radiotherapy or surgery. If the tumor is particularly early, even without radiotherapy and surgery, it can both preserve anus and cure the tumor, that is to do colonoscopy to remove the tumor. The fifth rule of Chrysanthemum Paulownia: find a colorectal surgeon who is experienced in anal preservation surgery. After the best treatment plan is formulated by the professional team and reasonable preoperative treatment is received, surgical radical removal of the tumor and successful preservation of the anus is a matter of course. The sixth rule of Chrysanthemum: adjust your mind, follow medical advice, live a healthy life and recover quickly. After the surgery, radiotherapy before and after the surgery and successful anal preservation, you will enter a long recovery process. This process may be very short for some people, a few weeks, and the function of the anus will be close to normal; however, for most people this process will be very long, months to a year or two after surgery to form regular bowel habits, and some people may even have abnormal bowel function for the rest of their lives. All treatments are a double-edged sword, all have their advantages but also bring corresponding complications, and the same is true for surgery and radiotherapy and chemotherapy. Surgery removes the rectal tumor, which is the most direct and complete treatment, but at the same time, surgery will also damage and destroy the nerve reflex of defecation and the function of some anal sphincter muscles, resulting in more frequent bowel movements or constipation, or even inability to control defecation and exhaustion on their own; although radiotherapy can shrink the tumor and improve the chance of anal preservation, it will also lead to radioactive enteritis, aggravate the above symptoms, and even lead to lead-like changes in the intestine, resulting in the inability to defecate and intestinal obstruction. This can lead to inability to defecate and intestinal obstruction. It sounds terrible, but the good thing is that the incidence of the above-mentioned serious complications is very low, and most people can recover to near normal after a long time of recovery. I often draw an analogy with my patient friends that a plate is broken, a good craftsman can repair it and continue to use it, but it is impossible to ask the plate to be restored to exactly the same as it was when it was not broken; a good treatment team does low and ultra-low anal preservation while removing rectal tumor, which is like repairing the broken plate, but it is impossible to ask the function of the anus to be restored to the same as it was before the surgery. It is impossible to restore the function of the anus to the same level as before the surgery, but it is enough to restore the function of stool control to near normal. Therefore, we hope that our patients can understand these conditions, adjust their psychology, cooperate with our medical advice and welcome this recovery process.