To achieve optimal management of rectal cancer, considerations should include the diagnosis and staging of the disease as well as physical condition of the patient. For benign lesion or early rectal cancer, transanal excision or transanal endoscopic microsurgery may be considered. For more advanced rectal cancer, radical resection with lymph node dissection is necessary. Ideally, total mesorectal excision should be included, with adequate distal and radical margins. For locally advanced rectal cancer, preoperative combined chemoradiation therapy may increase resectability and decrease the opportunity of permanent colostomy. Regarding associated functional changes of defecation, voiding and sexual function after operation, appropriate treatment and counsel should be provided.