OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer.This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation,and then received biofeedback treatments 1 month after the operation.The therapeutic responses were evaluated using the Vaizey and Wexner scor- ing systems and vectorial manometry.The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median fol ow-up was 4.2 years.No local recurrence was observed.The Vaizey and Wexner scores and vectorial manometry 1 month after operation 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 operation. CONCLUSION The local recurrence after the replacement opera- tion was low.The defecation function was poor early after operation,but increased markedly after biofeedback treatments and long-term functional exercise.This therapy can be one choice for very low rectal cancer. OBJECTIVE To assess the use of gluteus maximus muscle to reconstruct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation, and then received biofeedback treatments 1 month after the operation. Therapeutic responses were evaluated using the Vaizey and Wexner scor- ing systems and vectorial manometry. The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median fol ow-up was 4.2 years. No local recurrence was observed. Vaigy and Wexner scores and vectorial manometry 1 month after operation were significantly lower than those of the healthy and low anterior resection controls (P <0.001). After biofeedback treatments, the above The 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 r eflex only increased to 31.3% 1 year after operation. CONCLUSION The local recurrence after the replacement opera- tion was low. The defecation function was poor early after operation, but increased markedly after biofeedback treatments and long-term functional exercise. This therapy can be one choice for very low rectal cancer.