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Objective To analyze the efficacy of laparoscopic surgery combined with intraoperative radiotherapy (IORT) using mobile linear accelerator in the treatment of patients with locally advanced rectal cancer (LARC). Methods A retrospective analysis was made on 22 patients with LARC as study group who were treated with laparoscopy combined with IORT in our hospital from January 2012 to January 2016. A total of 44 patients were selected as control group using matched case-control design at 1∶2 based on age, sex, body mass index, mode of operation and tumor TNM stage. The patients in two groups were compared and analyzed. Results Average operative time in study group was longer than that in control group (P=0.024). There was no significant difference in postoperative exhaust time, fluid recovery time, postoperative hospital stay and short-term postoperative complications between study group and control group (P>0.05). The diffe-rences in both no local recurrence rate of 1-year (P=0.742) and 3-year (P=0.533) and overall survival rate of 1-year (P=0.476) and 3-year (P=0.447) were not significant between study group and control group. Conclusions Compared with laparoscopic surgery alone for LARC patients, laparoscopic surgery combined with IORT might increase the operative time. However, there was no significant difference in other operative indexes between two groups. Laparoscopic surgery with IORT could be done safe and feasible, and be comprehensive treatments for LARC patients.