Background and Aims: With the concept of total mesorectal excision (TME), the establishment of 2-cm distal margin rule, the application of stapler, and the development of intersphincteric resection (ISR) and other techniques, the anus-preserving rate of low rectal cancer has significantly increased. However, in "difficult pelvis" such as male, obesity, prostatic hypertrophy, post-radiotherapy, pelvic stenosis patients, achieving both goals of radical resection and anal preservation at the same time is still a big challenge. In recent years, the "bottom-up" laparoscopic transanal total mesorectal excision (TaTME) has emerged, and become a hot spot in the treatment of low rectal cancer. However, with the generalization of TaTME, anastomotic complications have remarkably increased. Therefore, how to improve the anastomotic technique and methods becomes the essential solution for reducing the anastomotic leakage after TaTME. This study was conducted to evaluate the effect and safety of TaTME combined with modified Bacon’s operation (pull-through procedure) in anus-preserving treatment of low rectal cancer. 
Methods: The clinical data of 62 patients with low rectal cancer who underwent TaTME from October 2016 to March 2019 were retrospectively analyzed. Of the patients, 32 cases underwent combined modified Bacon’s operation (observation group), and the other 30 cases underwent routine coloanal/rectal anastomosis. The relevant postoperative clinical variables were compared between the two groups of patients. 
Results: There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, length of specimen, length of distal margin, number of lymph node dissection, rate of positive circumferential resection margin, time to postoperative feeding, and time to ambulation (all P>0.05). The length of hospital stay in observation group was significantly longer than that in control group (10.33 d vs. 22.22 d, P<0.001). There was no significant difference in the incidence of sexual dysfunction, voiding dysfunction, and perianal infection between the two groups (all P>0.05). The incidence of anastomotic leakage in observation group was significantly lower than that in control group (0 vs. 16.7%, P=0.022); anastomotic stenosis occurred in 1 case (3.1%) in observation group and 4 cases (13.3%) in control group, which had no significant difference (P=0.189). There were no significant differences in Xu Zhongfa scores and Wexner scores 7 months and 12 months after operation between the two groups (all P>0.05). 
Conclusion: TaTME combined with modified Bacon’s operation has the advantages of two procedures, which not only guarantees the distal margin and circumferential resection margin of radical tumor resection, but also reduces the occurrence of anastomotic leakage, and its influence on anal function is not greater than that that of direct anastomosis. Its disadvantage is prolonged hospital stay. It is an appropriate alternative operation for low rectal cancer.