Objective To investigate the guidance of the endoscopic ultrasonography for the surgery selec-tion of patients with low rectal cancerthrough analyzing the accuracy of endoscopic ultrasonography in preoperative TN staging. Methods Eighty-seven cases with low rectal cancer received preoperative endoscopic ultrasonography examination,the preoperative staging and the postoperative pathologic comparison. The EUS accuracy of preopera-tive staging of rectal cancer was evaluated. Results The preoperative staging with endoscopic ultrasonography for patients with low rectal cancer,100% in T1 stage,96.0% in T2 stage,85.7% inT3 stage,and 100% in T4 stage. The preoperative staging and the postoperative pathologic comparison in T stage were consistent(Kappa = 0.903, P < 0.05). The preoperative staging with endoscopic ultrasonography for patients with low rectal cancer ,87.0% in N0 stage,78.6% in N1 stage,and 100% in N2. The preoperative and the postoperative pathologic comparisons in N stage were consistent(Kappa = 0.768,P < 0.05). Conclusion The endoscopic ultrasonography had a certain advantage in the clinical preoperative evaluation for patients with low rectal cancer ,especially for invasion depth and the judgment of lymph node metastasis ,with a higher accuracy.