Based on the background of a multidisciplinary treatment team and the increasing high-quality life aspirations of patients, the preservation of anal function for patients with low rectal cancer has undergone changes in recent years. With the optimization of neoadjuvant therapy, refinement of surgical techniques, and the deepening of the concept of anal preservation after surgery, the concept of anal preservation for low rectal cancer has gradually shifted from traditional simple surgery to comprehensive treatment, and anal preservation surgery tends to be more accurate preservation. The goal of comprehensive treatment is to preserve good anal function and reduce surgical damage. However, comprehensive treatment for anal preservation in low rectal cancer is still in its infancy, and there is no consensus on the strategy planning for anal preservation. Therefore, summarizing various preoperative, intraoperative, and postoperative treatment strategies for low rectal cancer is of great significance for the selection of anal preservation schemes for patients with low rectal cancer. This article focus on exploring the optimization of neoadjuvant therapy models, "watch and wait" plans, the development of anal preservation techniques, and postoperative and preservation strategies, aiming to review the current status of anal preservation strategy planning for low rectal cancer.