Objective To investigate the types and number of symptom clusters in patients undergoing sphincter-preserving surgery for rectal cancer and explore the influencing factors of these symptom clusters.Methods Totally 192 patients who underwent sphincter-preserving surgery for rectal cancer in the Department of General Surgery at Peking University Third Hospital between January 2021 and January 2023 were selected by convenience sampling.A general information questionnaire,Post-sphincter-preserving Surgery Symptom Questionnaire,and the International Physical Activity Questionnaire-Short Form(IPAQ-SF)were used for data collection.Results A total of 192 questionnaires were distributed,with 159 valid questionnaires returned.Exploratory factor analysis on 18 symptoms with an incidence rate of over 10.0%identified five primary symptom clusters:the psychological symptom cluster,increased defecation cluster,fatigue-pain cluster,sleep disturbance cluster,and constipation-related cluster.Logistic regression analysis showed that postoperative duration was an influencing factor for the psychological symptom cluster(P<0.05);preoperative radiotherapy and postoperative duration were influencing factors for the increased defecation cluster(P<0.05);postoperative chemotherapy was an influencing factor for the fatigue-pain cluster(P<0.05);and weekly sedentary time was an influencing factor for the sleep disturbance cluster(P<0.05).Conclusions Patients undergoing sphincter-preserving surgery for rectal cancer experience multiple symptom clusters.Preoperative radiotherapy and prolonged sedentary behavior increase the risk of symptom clusters,and different postoperative periods are associated with varying risks for different symptom clusters.However,physical activity levels do not appear to influence the occurrence of symptom clusters.Healthcare providers should implement targeted interventions based on the symptom clusters and their influencing factors to reduce the incidence of symptoms in patients.