Abstract: Objective To investigate the clinical efficacy and feasibility of preservation of the left colonic artery (LCA) in laparoscopic anterior resection of low rectal cancer. Methods The clinical data of 52 patients treated with laparoscopic anterior resection in our hospital from September 2014 to February 2018 were analyzed retrospectively and 52 patients were divided into two groups according to the operation method, including 26 cases with preservation of the LCA and 26 cases with high ligation group in inferior mesenteric artery (IMA). The differences of two groups on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, postoperative anal exhaust time, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months were analyzed and compared. Results There were no differences between LCA group and IMA group on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months (all P>0.05). In IMA group, the postoperative anal exhaust time was (2.80±0.52)d, and postoperative anastomotic leakage number was 6 cases; in LCA group, the postoperative anal exhaust time was (2.44±0.44)d, and postoperative anastomotic leakage number was 0 case; the differences between the two groups were statistically significant (all P<0.05). Conclusion The clinical efficacy of preservation of the left colonic artery (LCA) in laparoscopic anterior resection is equivalent with high ligation group in inferior mesenteric artery. And preservation of LCA could effectively reduce the anal exhaust time and anastomotic fistula rate.