Abstract: Objective: To explore rational surgical treatment for low rectal villous adenoma with canceration. Methods： Twenty-eight cases of distal rectal villous adenoma with canceration undergoing local excision were analyzed retrospectively. Results： Twenty patients underwent transanal excision and 8 with Kraske resection. Twenty-seven showed high or middle differentiation and only 1 showed low differentiation in pathology after operation; tumors confined to the mucosa and submucosa were 13 and 12 respectively, only 3 lesions infiltrated to the muscularis. 4 suffered recurrence and 2 metastasis; the 5-year survival rate was 78.6% (22/28). Conclusions： Most rectal villous adenomas with canceration were less invasive;for the patients adapted to the indication, local excision could not only cure the tumor, but also promoted the living standard.