Abstract: Surgery is the basis of the treatment for rectal cancer, especially for low rectal cancer. How to maintain a good quality of life and keep physiological function for patients after surgery while pursuing a long-term survival has been an important issue. In recent years, function preservation operation for low rectal cancer has continuously developed because of the deep understanding of the pathology and molecular pathology of rectal cancer, optimization and development of multidisciplinary diagnosis and treatment, introduction of total mesorectal excision and pelvic autonomic nerve preservation, and the continuous innovation of medical equipment and surgical operation. The development of rectal cancer surgery will undoubtedly be more manifested in functional preservation and protection. For low rectal cancer patients, achieving maximum function preservation under the premise of radical resection relies on the precise treatment based on evidence-based medicine and the individualized anus preserving operation.