Introduction. Most patients with anal cancer were recommended to treat with chemoradiotherapy. However, some patients may still receive surgery in the hope of improving oncologic outcomes. In this study, we analyze the oncologic outcome of patients with anal cancer from different types of treatment and review the literature. Method. We collected patients with anal cancer and have been treated in the colorectal department in Chung Gung Memorial Hospital from 1997 to 2020. Clinicopathologic variables were collected. We performed univariate and multivariate analyses for overall and disease-free survival. For subgroup analysis, all patient was classified into three groups according to treatment type: operation only, CCRT only, and operation plus CCRT. Result. In univariate analysis, patients with SCC have significantly better overall survival than adenocarcinoma. Patients with distant metastasis have significantly worse overall survival and disease-free survival than those without. There was no significant difference between different T stages and N stages. In multivariate analysis (Table 3), only patients with distant metastasis showed significantly worse overall survival than others. In subgroup analysis, in patients with stage I-II anal cancer, there was no significant difference between these patients undergoing CCRT with or without operation (0.57 vs. 0.72, p = 0.206, Fig. 1A). No difference was found between these patients undergoing local excision with or without CCRT (0.89 vs. 0.67, p = 0.243, Fig. 1C). Worse overall survival for patients with stage III-IV disease treated with operation plus CCRT than with CCRT only (0.08 vs. 0.66, p < 0.05). Conclusion. Early anal cancer can be treated with local excision or definite CCRT without significant difference. Surgery has no benefit but worse survival for patients with uncontrolled distant disease.