Objective To summarize our 13-year experience with conformal sphincter preservation operation (CSPO) for low rectal cancer, evaluate perioperative safety and oncologic outcomes, and assess the impact of technical refinements on postoperative anorectal function. Methods A total of 332 patients with low rectal cancer who underwent CSPO at The First Affiliated Hospital of Naval Medical University from Jan. 2012 to Dec. 2024 were retrospectively enrolled. They were categorized into early-period group (2012-2019) or recent-period group (2020-2024). Perioperative data and postoperative anorectal function were compared between the 2 groups. Results All 332 patients successfully underwent CSPO. The early- and recent-period groups included 155 and 177 patients, respectively. There were no significant differences in intraoperative blood loss (［43.94±19.07］ mL vs ［41.35±13.70］ mL, P＝0.162) or operative time (［180.20±69.03］ min vs ［187.22±49.98］ min, P＝0.285) between the 2 groups. Compared with the early-period group, the recent-period group showed a markedly higher rate of minimally invasive surgery (90.4% ［160/177］ vs 41.3% ［64/155］, P＜0.001), an increased use of transanal conformal resection (76.3% ［135/177］ vs 14.2% ［22/155］, P＜0.001), a higher proportion of hand-sewn anastomosis (54.2% ［96/177］ vs 19.4% ［30/155］, P＜0.001), and a shorter postoperative hospital stay (6 ［6, 6］ d vs 6 ［6, 7］ d, P＜0.001). There was no significant difference in the incidence of postoperative complications between the 2 groups (22.6% ［40/177］ vs 29.0% ［45/155］, P＝0.181). Kaplan-Meier survival analysis showed that the 3- and 5-year disease-free survival (DFS) rates of the overall cohort were 85.6% and 81.8%, respectively; the corresponding overall survival (OS) rates were 93.1% and 89.9%, respectively. Functional assessment showed that among the 214 patients who had undergone stoma reversal for at least 1 year, the overall Wexner incontinence score was 5.50 (3.00, 9.00), and the low anterior resection syndrome (LARS) score was 29.00 (20.00, 34.00). Both scores were lower in the recent-period group than in the early-period group (Wexner incontinence score: 5.00 ［2.00, 8.00］ vs 6.00 ［4.00, 10.00］, P＝0.034; LARS score: 25.00 ［16.00, 32.00］ vs 31.00 ［25.00, 36.00］, P＜0.001). Meanwhile, the incidence of severe LARS (LARS score ≥30) was lower in the recent-period group (36.4% ［39/107］ vs 56.1% ［60/107］, P＝0.004). Conclusion CSPO enables safe sphincter preservation for low rectal cancer, demonstrating favorable clinical value and long-term oncological safety. In recent years, technical refinements, particularly transanal transection and hand-sewn anastomosis, have been associated with improved postoperative functional outcomes.