Abstract: Objective To evaluate the clinical significance of preservation of the left colonic artery(LCA)in laparoscopic radical resection of rectal cancer in elderly patients. Methods Clinical data of 204 rectal cancer patients undergoing laparoscopic radical resection was retrospectively analyzed, 98 cases with preservation of LCA were selected as preservation group and 106 cases without preservation of LCA were included in non-preservation group. Operation-related conditions were compared between the two groups. Results Operation time was significantly longer in the preservation group than that in the non-preservation group ［(121.41±14.02)min vs.(109.74±12.92)min, P<0.01］. The cololysis of splenic flexure in the preservation group was significantly higher than that in the non-preservation group(P<0.05). The preservation group underwent no preventive terminal ileum stoma, and 6 cases in the non-preservation group received preventive terminal ileum stoma, a significant difference was found in two groups(P<0.05). No significant differences in terms of total number of lymph node dissection and the number of lymph node(No.253)dissection, intraoperative blood loss, postoperative exhaust time, proximal colonic ischemia, anastomotic bleeding, anastomosis leakage were found between the two groups(P>0.05). Conclusion Preservation of the left colonic artery in laparoscopic radical resection of rectal cancer in elderly patients can reduce preventive terminal ileum stoma, conform to the requirement of radical clearance of lymph nodes, and it is safe and feasible in technology.