Abstract:

The management of low rectal cancer has evolved from a radical "life-saving" paradigm through an era of sphincter preservation into a new epoch prioritizing function preservation, representing a transformative leap rooted in systematic innovations across surgical philosophy, technological capabilities, and therapeutic procedures. This evolution is epitomized by the revolutionary refinement of safe distal resection margins from the traditional "5-cm principle" to the contemporary "1-cm principle", which has catalyzed the development of sphincter-preserving procedures while fundamentally elevating the decision-making paradigm from "anatomic sphincter preservation" to the more sophisticated concept of "functional sphincter preservation". Technically, laparoscopic and robotic surgeries have achieved minimally invasive and precise operations, and the advancement of surgical instruments has ensured the reliability of deep pelvic anastomosis. The neoadjuvant therapy model has evolved from traditional radiotherapy and chemotherapy to total neoadjuvant therapy (TNT) and immunotherapy, significantly improving the rate of pathological complete response (pCR), laying a scientific foundation for the "watch-and-wait" strategy. Radiomics contribute to the precise preoperative assessment. The ultimate aim is to comprehensively integrate the latest theoretical advancements, smoothly applies them to practice, builds a standardized diagnosis and treatment system. Ultimately, while ensuring the safety of oncology, this initiative will customize individualized treatment plans for each patient of low rectal cancer, shifting the paradigm from merely "curing the disease" to "healing the patient".

Key words: Low rectal cancer, Functional sphincter preservation, Surgical treatment, Neoadjuvant therapy, "Watch-and-wait" strategy