Abstract: The treatment paradigm for locally advanced colorectal cancer is experiencing a paradigm shift, with a comprehensive transition from postoperative adjuvant therapy to an integrated model centered on neoadjuvant therapy. Clinical studies have established that neoadjuvant chemo-radiotherapy improves local control, while total neoadjuvant therapy significantly increases the pathological complete response rate, providing opportunities for organ preservation strategies and advancing treatment goals from radical cure alone to include functional preservation and quality of life improvement. The neoadjuvant immunotherapy for patients with deficient mismatch repair/microsatellite instability‑high has brought unprecedented high response rates, which is expected to reshape the treatment standards for such patients. These therapeutic advances are profoundly influencing surgical principles, where leveraging treatment response to achieve minimally invasive and function‑preserving procedures has become pivotal, provided oncological safety is ensured. All such individualized decision‑making critically relies on the systematic coordination by multi⁃disci-plinary teams, complemented by longitudinal monitoring using novel biomarkers such as circulating tumor DNA, marking the field′s entry into a new era of precision medicine.