Abstract: Objective : To assess the use of gluteus maximus muscle to reconstruct the anal sphincter for very low rectal cancer. This study aimed to evaluate local recurrence and function of the new anal sphincter after surgery. Methods : Sixteen patients underwent the replacement procedure and then received biofeedback treatments 1 month after the operation. The therapeutic responses were eval-uated using the Vaizey and Wexner scoring systems and vectorial manometry. The 2 control groups were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. Results : Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry results 1 month after surgery were significantly lower than those of the healthy and low anterior resection controls (P<0.001). After biofeedback treatments, the above indexes improved significantly (P<0.001)，especially after 1 year (P<0.001)，but still remained lower than the controls (P<0.001). The rectoanal reflex only increased to 31.3% 1 year after the surgery. Conclusion : Local recurrence was low after the replacement surgery. Defecation function was poor immediately fol-lowing the surgery, but improved markedly after biofeedback treatments and long-term functional exer-cise. This therapy is one suitable choice for very low rectal cancer.