The patient was a 70s man, whose chief complaint of Hematochezia. He visited neighborhood hospital and was diagnosed with lower rectal cancer by colonoscopy. Preoperative CT showed a mass in the bladder, which led to a diagnosis of multiple early stage bladder cancer after a thorough urological examination. We diagnosed that very low anterior resection was necessary for rectal cancer and total bladder resection was necessary for bladder cancer. The patient underwent robotic- assisted total pelvic exenteration with anal preservation. One year and three months have passed since the surgery, and no signs of recurrence have been observed.