The current domestic and international guidelines recommend neoadjuvant chemoradiation or total neoadjuvant therapy followed by radical surgery for mid-low locally advanced rectal cancer. In recent years, the significant efficacy of immune checkpoint inhibitors has been recognized for patients with microsatellite instability-high/mismatch repair deficiency. The latest researchs show that in the neoadjuvant therapy of microsatellite stability/mismatch repair proficient rectal cancers, combining immune checkpoint inhibitors with radiotherapy can also achieve significant tumor regression, which is expected to usher in a new era of neoadjuvant therapy for rectal cancer. Even so, surgery remains pivotal in the current multidisciplinary diagnosis and treatment modelity for rectal cancer. However, it can be foreseen that a more significant preoperative tumor regression will greatly promote the widespread use of minimally invasive surgery. The minimally invasive surgery for rectal cancer represented by transanal endoscopic microsurgery, transanal total mesorectal excision, laparoscopic total mesorectal excision plus removal of specimens through natural cavity is hopeful to be further promoted and become the standard surgery in the era of radiotherapy combined with immunotherapy for rectal cancer.