From anal preservation to functional preservation: the application value of colonic pouch in low anterior resection of the rectum

As sphincter‑preserving techniques for low rectal cancer have become wides-pread, postoperative low anterior resection syndrome has emerged as a core bottleneck affecting patients′ long‑term quality of life. The shift from "preserving sphincter function to preserving func-tional capacity" has gradually become a key objective in precision surgery. The authors systematically review the value of colonic pouch in low anterior resection for rectal cancer, covering their physiolo-gical mechanisms, technical evolution, evidence‑based data, and indication strategies, summarize key technical aspects of pouch construction, strategies for preventing complications and managing functional disorders, and propose a quality management system centered on preoperative assessment, intra-operative blood supply and tension control, and structured postoperative follow‑up. In the future, reservoir reconstruction will leverage artifical intelligence planning, 3D modeling, and multicenter real‑world data to achieve more precise, individualized functional restoration. By promoting standar-dized pathways and a function‑oriented approach, patients with low rectal cancer can expect to achieve superior functional outcomes and quality of life alongside tumor eradication.