In 1836, the French surgeon Charles-Pierre Denonvilliers first described the existence of a thin layer of dense tissue between the male rectum and the bladder, seminal vesicles and prostate, later known as Denonvilliers' fascia. In 1982, Professor R.J. Heald proposed the concept of total mesorectal excision (TME). After decades of clinical practice, TME has become the gold standard for mid-low rectal cancer surgery. According to the TME concept, the posterior and lateral sides of the rectum should be separated between the inner surface of the pelvic fascia parietal and the rectal fascia propria, while the anterior rectum should be separated in front of the Denonvilliers' fascia, and the inverted U-shaped dissection and excision should be performed at 2 cm below the tumor, and part of the Denonvilliers' fascia should be removed. However, data show that the incidence of urinary and sexual dysfunction after TME remains high due to pelvic autonomic nerve (PAN) damage. Therefore, further clarifying the understanding of pelvic fascia and autonomic nerve anatomy is particularly important for improving postoperative function of patients. On the basis of previous research, we conducted an in-depth exploration of the pelvic fascia and surgical aspects from the perspectives of embryonic development, anatomy, histology and surgery, and pointed out that Denonvilliers' fascia does not belong to the category of rectal fascia propria. We proposed the concept of Denonvilliers' fascia-sparing total mesorectal excision (iTME), and validated it using a multicenter prospective randomized controlled clinical trial. On this basis, we formulated the iTME Chinese expert consensus, aiming to improve practitioners' understanding of neurological protection, standardize surgical operations, and benefit the majority of patients.