Colorectal cancer is a highly prevalent malignant tumor worldwide. In recent years, the incidence and mortality rates in China have been increasing year by year. It is also shown a significant trend of younger onset. Metastasis and recurrence are the main causes of death in the patients. The diagnosis and treatment of locally advanced rectal cancer ( LARC) and recurrent rectal cancer (LRRC) remains a clinical difficulty. This article reviews the research progress in the precise imaging diagnosis, optimization of neoadjuvant therapy strategies, surgical technique innovation and postoperative nursing for LARC and LRRC. The article also summarizes key breakthroughs in rectal cancer treatment in recent years. It aims to provide safer and more efficient diagnostic and therapeutic approaches for clinical practice.