Abstract： Total mesorectal excision is the standard surgical procedure for rectal cancer.Based on this,the intersphincteric resection and conformal sphincter-preserving operation have pushed the sphincter-preserving surgery for ultra-low rectal cancer to the limit.However,no matter what kind of surgery,patients still need to face stoma or anal dysfunction,which seriously affect the quality of life.The"watch and wait"strategy for patients who achieve clinical complete response after neoadjuvant chemoradiotherapy has provided novel therapeutic method for rectal cancer,making non-surgical treatment possible.Total neoadjuvant therapy has expanded the application of the watch and wait strategy and has been written to the guidelines.Meanwhile,the rise of immuno-therapy has changed the treatment pattern of tumors.It has been the first-line treatment for advanced colorectal cancer with mismatch repair deficiency or microsatellite instability-high.As for patients with proficient mismatch repair or microsatellite stability,researches focus on how to improve the effect of neoadjuvant radiotherapy combined with immunotherapy,so that more patients with low rectal cancer have the opportunity to achieve clinical complete response and enter the watch and wait procedure,which will achieve the purpose of preserving the anus or rectum.The authors elaborate on current status of sphincter-preserving strategies for low rectal cancer and the strategies in the era of immunotherapy,in order to provide references for treatment of low rectal cancer.