Low rectal cancer is a common gastrointestinal malignancy. Organ preservation in the treatment of low rectal cancer is a challenge. By combining surgical resection with freezing—a complementary treatment for low rectal cancer—the anus can be preserved in some patients. However, we lack unified standards for colorectal cancer cryotherapy. Our hospital has been treating patients with cryotherapy since 1976. In our department, the indications for and contraindications to low rectal and anal cancer treatment are well established. In this paper, we summarize the indications for and contraindications to cryotherapy for colorectal cancer by reviewing the literature, drawing on our experience, and considering current imaging and histological techniques. Our aim is to facilitate clinical discussion and promote appropriate treatment.

Rationale: In the treatment of low rectal cancer (LRC), preserving the anal sphincter is increasingly attracting the attention of colorectal surgeons. Many patients refused to perform a colostomy. Here, we report a case of LRC in a middle-aged woman and the clinical implications of the symptom, the treatment process of LRC, and the complications. Patient concerns: A 46-year-old woman visited our department with a tumor found on her physical examination because of hemafecia. Then she refused to perform abdominoperineal resection. Diagnosis: The patient first completed a colonoscopy and then underwent a rectal biopsy. The tumor was diagnosed as a rectal adenocarcinoma after pathological evaluation. Then it was staged by magnetic resonance imaging and enhanced computed X-ray tomography. Interventions: The treatment consisted of chemoradiotherapy followed by cryoablation. Outcomes: The patient achieved a good oncological outcome and preserved the sphincter successfully. The post-cryoablation course of the patient was uneventful and he remained healthy at the 1-year follow-up. Lessons: The preservation of anal sphincters has attracted more and more attention from colorectal surgeons. From the patient's perspective, the preservation of the anal sphincter was a key part of her treatment. We should try to meet the wishes of patients on the basis of curing the disease.