Objective: To evaluate the predictive value of pelvic anatomical parameters measured by preoperative CT and pathological parameters for the difficulties when performing laparoscopic rectal surgery for mid-low rectal cancer and establish a scoring system for predicting. Methods: We performed univariable analysis of anatomical parameters by preoperative CT and pathological parameters in 80 patients laparoscopic rectal surgery for mid-low rectal cancer in our department between October 2014 and February 2018. Multiple logistic regression was performed to identify risk factors that were subsequently scored. A scoring system was then established. ROC curve was used to evaluate the value of this scoring system. Results: The risk factors influencing the difficulty level of laparoscopic rectal surgery for mid-low rectal cancer included tumor location, the ratio of height of the pubic symphysis to anteroposterior diameter of the mid-pelvis, the ratio of height of the pubic symphysis to interspinous diameter. A higher score after establish scoring system by above factors was associated with a more difficult operation. Conclusion: Lower tumor location, deeper and narrower pelvis caused an increase in the difficulty of surgery. The establishment of the scoring system is helpful for the preoperative screening cases to choose the best Surgical method.