|Aim: To clarify long-term oncological and functional outcomes of sphincter preserving surgery for lower rectal cancer. Mehods: 266 patients who were curatively treated for primary lower rectal adenocarcinoma between 2000 and 2012 in single tertiary referral hospital were included in this restrospective study. Of this cohort, 122 patients underwent intersphincteric resection (ISR). Local oncological outcome was analyzed by anastomotic recurrence and functions were assessed by Wexner score an mFIQL score using a mail questionnaire. Results: Metastases of lymph nodes (Odds ratio 3.30, p=0.020) and ISR (Odds ratio 3.42, p=0.027) were independently risk factors of anastomotic recurrence. Of the patients who underwent ISR, anastomotic recurrence was found in 30% of patients with pStageIIIb and 20% of patients who underwent total ISR or partial external sphincter resection (ESR). Comparing functions between low anterior resection, partial ISR, and total ISR or partial ESR, there were no significant difference about bowel movements, urgency and irritation. However, Wexner score and mFIQL score (5 vs 8 vs 10, p<0.001, 21.4 vs 42.9 vs 39.2, p=0.018) were significantly high in total ISR or partial ESR. Conclusions: Metastases of lymph node and ISR were the risk factors of anastomotic recurrence after sphincter-preserving resection for lower rectal cancer. Total ISR and ESR were not strongly recommended in terms of anastomotic recurrence and function.