Transanal total mesorectal excision (taTME) which aims to achieve more accurately complete resection of distal mesorectum has arouse much more attention worldwide. TaTME can significantly improve the local control (LC) and overall survival (OS) of the patients with locally advanced rectal cancer. Intraoperative radiotherapy (IORT), also as a emerging treatment method for locally advanced tumors, can lead to the potential for dose escalation, reduce overall treatment time, and increase patient convenience. Our study firstly combined taTME and IORT for the treatment of locally advanced rectal cancer. The tumor involved 60 mm rectal wall and located 30 mm from anal margin. TaTME and IORT were successfully achieved in this patient. There was no obvious complications occurred, including the anastomotic fistula. The patient recovered well and further systematic systematic chemotherapy and radiotherapy were suggested. We conclude that taTME with low-energy X-rays IORT may not only benefit the circumferential resection margin (CRM) but also improve the local control (LC) for the patient with locally advanced rectal cancer.