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Background: Advances in surgical techniques and multimodal treatment have led to the possibility of sphincter preservation in patient who have traditionally required abdominoperineal resection (APR) in the past. Objective: Evaluation of Coloanal Anastomosis after Resection Low Rectal Cancer. Patients and Methods: This study of case series included a total 10 patients who underwent total mesorectal excision and colo-anal anastomosis attending at Damanhur Oncology Center. Results: As regard histopathology, 3 patients (3%) showed well differentiated adenocarcinoma and 7 patients (70%) showed moderately differentiated adenocarcinoma. As regard TNM staging, 1 patient (1%) was T1N0M0, 3 patients (30%) were T3N0M0, 2 patients (20%) were T3N1M0 and 4 patients (40%) were T3N2M0. Conclusion: The ISR and CAA technique provides an opportunity to perform sphincter saving surgery in treatment of distal rectal cancer. This technique performs with acceptable functional outcomes.