Abdominoperineal resection (APR) is a standard procedure for low rectal cancer. However, avoiding a permanent colostomy thereby improving the quality of life has long been a desire of patients as well as a great challenge to surgeons. Total anorectal reconstruction (TAR) after APR is to prevent those changes in physical appearance and defecation function resulting from permanent colostomy by various reconstructive procedures to reconstruct rectum and the function of internal and external sphincters. Here, the author presents the current status and progress in this field.