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Colorectal cancer is one of the most common malignancies in the world, and rectal cancer accounts for a large percentage of this disease in Chinese patients. Surgical extirpation is the mainstay of therapy, Intraluminal ultrasound is highly accurate in detecting depth of invasion and lymph node metastasis, and is also helpful in preoperative staging of rectal cancer. Preoperative adjuvant therapy could down-stage tumors, improve the radical resection rates of advanced lower rectal cancer, increase the rate of sphincter-saving surgery, and decrease the local recurrence rate. Total mesorectal excision could signifi-candy decrease the local metastasis of rectal cancer, and rectal cancer resection with preservation of pelvic autonomic nerve is effective in preventing urinary or reproductive dysfunction. Recently, minimally invasive surgery has been introduced for the management of rectal cancer, and transanal endoscopic microsurgery is a new method with advantages in rectal cancer treatment.