Abstract:Intersphincteric resection (ISR) has become an important ultimate sphincter-preserving procedure for low rectal cancer. With advances in anatomical understanding and minimally invasive techniques, several expert consensuses have been published worldwide to standardize ISR. In 2023, the International Standardization and Optimization Group for Intersphincteric Resection (ISOG-ISR) released a modified Delphi consensus that systematically addressed the anatomical basis, definition, indications, surgical techniques, and functional assessment of ISR. In the same year, the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association published the Chinese expert consensus on intersphincteric resection for low rectal cancer (2023 edition), integrating current evidence with Chinese clinical practice to summarize key anatomical concepts, perioperative management, and long-term outcomes. From an anatomical perspective, this article provides a comparative interpretation of the domestic and international consensuses, focusing on the definition of ISR, intersphincteric anatomy, indications and contraindications, surgical approaches and technical details, margin assessment, and postoperative functional outcomes. In addition, recent advances involving novel concepts such as the intersphincteric complex are discussed to further analyze the anatomical basis underlying the differences between the consensuses and their potential surgical implications. This review aims to provide references for the standardized and precision-oriented development of ISR.