In recent years, significant achievements have been made in the research on surgical treatment of low rectal cancer, especially the application of function-preserving surgery, which has further improved tumor prognosis and patients’ quality of life. This article introduces the latest progress in function-preserving surgery for low rectal cancer, summarizes the evaluation and monitoring methods for anal sphincter function and urogenital function, and discusses the surgery-related factors affecting tumor prognosis. Future research directions should focus on optimizing the comprehensive strategies of function-preserving surgery and individualized precision treatment, verifying the short-term and long-term efficacy of different surgical methods through multi-center prospective randomized controlled trials, and finding a balance between tumor radical cure and function preservation, so as to further improve the treatment effect and patients’ quality of life.