[Sphincter-preserving surgery for rectal cancer--From limits to perfection]

Sphincter-preserving therapy for low rectal cancer has always been a difficult and hot topic in colorectal cancer. Advanced understanding of the biological behavior of rectal cancer and the pelvic fascial anatomy have laid the theoretical foundation for sphincter preservation, shifting the surgical paradigm from radical resection alone toward both oncological safety and function preservation. Guided by the principle of TME and supported by minimally invasive technologies, a variety of surgical methods including low anterior resection(LAR), Bacon, intersphincteric resection(ISR), conformal sphincter-preservation operation(CSPO) and transanal total mesorectal excision(taTME), have progressively pushed the sphincter-preserving surgery to the limit in the inheritance of history. In addition to surgery, non-surgical management based on the "Watch & Wait" strategy provides a new sphincter-preserving option for selected patients. Meanwhile, the rise of immunotherapy is reshaping the pattern of sphincter-preserving treatment in the future. The continuous trial and exploration of immunotherapy combined with neoadjuvant therapy in protein mismatch repair proficient(pMMR)/microsatellite stable(MSS) patients is expected to further improve the overall rate of sphincter preservation rate and organ preservation. In the future, sphincter-preserving treatment for low rectal cancer will be more patient-centered. By integrating the advantages of precision medicine and multidisciplinary collaboration, and giving full play to the potential of artificial intelligence, patients will achieve the best balance between oncology safety and function preservation.