Intraoperative pelvic autonomic nerve (PAN) damage is major reason of postoperative urogenital dysfunction in treating patients with rectal cancer. The accurate identification and preservation of PAN, which should be tricky during the operation, is the key points of proctectomy. In order to maintain the dissection in the right surgical plane, the surgeon should be familiar with both anatomy of PAN and perirectal fascia, thus could minimize the damage to PAN.Nowadays, by using advanced laparoscopic equipment and evolvement of pelvic anatomical theory, the surgeons could discriminate the configurations of nerves, vessels and fascia in pelvis in a more precise and efficient way. In this review, we stressed the significance of pelvic autonomic nerve preservation in proctectomy for rectal cancer, and discussed a few surgical techniques to do that.