Sphincter preservation resection has been the first choice for rectal cancer, not only for high and mid-rectal cancer, but also for low rectal cancer. Were sphincter preservation resection indicated and suitable for all of the patients with rectal cancer? The aim of this paper is to discuss when sphincter preservation resection should be chosen? Firstly we should have a thorough preoperative assessment for the patients. After that we should determine the indications of sphincter preservation resection according to the NCCN guideline. Meanwhile, surgical approach should be balanced between long term survival and functional outcomes.As a result, what is most important in sphincter preservation resection is reaching satisfaction both in curative resection and functional outcomes. These are also the reasons for rational utilization of sphincter preservation resection for rectal cancer.