Objective To compare the outcomes of low/ultra-low anterior rectal resection and valgus resection in elder patients with rectal or anal cancer. Methods The clinical data of 184 patients with rectal or anal cancer， who were treated with extreme sphincter preserving surgery in West China Hospital from January 2009 to December 2011， were collected and analyzed retrospectively. The intraoperative and postoperative indexes between low/ultra-low anterior rectal resection group and valgus resection group were compared. Results ①There were no significant differences in the age，body mass index， gender， diameter of tumor， TNM stage， degree of differentiation， histological type， gross type， and complications before operation， such as hypertension， chronic obstructive pulmonary disease， cardiovascular diseases， diabetes， renal disease， and hypoproteinemia in two groups （P＞0.05）. ②Compared with the low/ultra-low anterior rectal resection group， the distance from the anal verge to the tumor was shorter （P＜0.05） and the distance of distal resec-tion margin of tumor was longer （P＜0.05） in the valgus resection group. ③There were no significant differences in the operation time， blood loss， ASA grade， and the postoperative complications in two groups （P＞0.05）. ④There were no significant differences in the duration of pulling out nasogastric tube， urinary catheter， and drainage tube， the duration of first passing flatus， first defecation， first oral intake， and first ambulation， and hospitalization cost （P＞0.05）. But the postoperative hospital stay and total hospital stay in the valgus resection group were significantly longer than those in the low/ultra-low anterior rectal resection group （P＜0.05）. ⑤All the patients were followed-up for 6-24 months （average 13 months）. During the following-up， only 1 case suffered local tumor recurrence in the valgus resection group. One case suffered distant metastases in the ultra-low anterior rectal resection and valgus resection group， respectively. Eight cases （4.35%） died， of which 4 cases （4.04%） in the low/ultra-low anterior rectal group and 4 cases （4.71%） in the valgus resection group. All the patients were in functional recovery of anal control after operation. Conclusions As the extreme sphincter preserving surgery for elder patients with rectal or anal cancer， the low or ultra-low anterior rectal resection and valgus resection could both be used for elder patients with extreme-low rectal or anal cancer. However， valgus resection results in longer distal surgical margin than that low/ultra-low anterior rectal resection， and it is suitable for the patients with shorter distances from the anal verge to the tumor.