Low rectal cancer represents one of the most challenging conditions in colorectal surgery due to its anatomical proximity to the anal sphincter complex and its significant impact on postoperative quality of life. Historically, abdominoperineal resection with permanent colostomy was considered the standard surgical approach for tumors located in the distal rectum. However, advances in oncologic principles, imaging modalities, neoadjuvant therapy, and surgical techniques have enabled sphincter-preserving surgery to become a feasible and safe option for selected patients with low rectal cancer. This thesis reviews the contemporary management strategies for low rectal cancer with a focus on sphincter-preserving procedures, including low anterior resection, intersphincteric resection, and transanal total mesorectal excision. Emphasis is placed on patient selection, oncologic safety, functional outcomes, and the role of multimodal treatment. Evidence indicates that sphincter-preserving surgery, when performed according to strict oncologic criteria, achieves comparable local control and survival outcomes while significantly improving patient quality of life.

Abdominoperineal resection (APR) remains a standard surgical approach for patients with low rectal adenocarcinoma when sphincter preservation is not oncologically feasible. Despite its effectiveness in achieving local disease control, APR is associated with a high incidence of postoperative male sexual dysfunction, primarily erectile dysfunction and ejaculatory disorders. These complications arise mainly from injury to the pelvic autonomic nervous system during deep pelvic dissection. This article reviews the anatomical and pathophysiological mechanisms underlying sexual dysfunction after APR, evaluates nerve-sparing surgical strategies, and summarizes clinical evidence on functional outcomes. A narrative analysis of published clinical studies indicates that preservation of the hypogastric nerves and pelvic plexus significantly improves postoperative sexual function without compromising oncologic radicality in selected patients. Comprehensive preoperative assessment and structured postoperative rehabilitation are essential components of patient-centered care. Integrating nerve-sparing principles into APR, when oncologically safe, can mitigate sexual morbidity and improve long-term quality of life.