摘要局部进展期结直肠癌的治疗范式正经历根本性转变，术后辅助治疗已转变为以新辅助治疗为核心的综合治疗模式。循证医学证据表明：新辅助放化疗优化局部控制，全程新辅助治疗进一步提升病理学完全缓解率，为观察等待等器官保留策略提供机会，推动治疗目标从单纯根治跃升至功能保全与生命质量提升并重。针对错配修复功能缺陷和（或）微卫星高度不稳定患者，新辅助免疫治疗更带来前所未有的高缓解率，有望重塑该类患者的治疗标准。外科实践也随之改变，在确保肿瘤学安全的前提下，将微创与功能保留理念付诸实践。所有个体化决策高度依赖多学科团队的全程管理，并结合循环肿瘤DNA等新型生物标志物进行动态监测，共同标志着结直肠癌领域精准医疗新纪元开启。

abstractsThe 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.