Abstract: Low rectal cancer accounts for a high proportion of colorectal cancer cases in China, and the choice of treatment strategies critically impacts patient prognosis and quality of life. With the advancement of precision treatment, clinical decision‑making requires integrating multi⁃dimensional factors to move beyond the traditional "one‑size‑fits‑all" approach. The authors focus on the anatomical complexity, high recurrence risk, and functional preservation demands of low rectal cancer, incorporating the latest research advances to explore precision treatment pathways in terms of preoperative high‑resolution magnetic resonance imaging assessment, breakthroughs in immunotherapy and precision surgical techniques. Future efforts should further optimize individua-lized strategies through multimodal assessment and multidisciplinary collaboration, refining inte-grated approaches based on evidence‑based medicine to enhance clinical efficacy and patient survival outcomes.