Objective To analyze the advantages and disadvantages of various neoadjuvant therapy , provide reference for clinical diagnosis and treatment, and provide direction for further research and exploration. Method The recent domestic and international medical databases (PubMed, EMBASE, Cochrane Library, VIP database, CNKI, WanFang database, etc.) were searched and the relevant literature on neoadjuvant therapy for locally advanced rectal cancer (LARC) were reviewed. Results Neoadjuvant therapy could decrease tumor staging, increase anal reserving rate, and reduce local recurrence rate, but it does not significantly reduce the rates of distant metastasis and lateral lymph node metastasis, nor does it improve long-term survival. More and more optimization neoadjuvant therapy had emerged. Molecular targeted drugs and immunotherapy were being attempted for clinical using, combined with research on emerging biomarkers, to improve the therapeutic efficacy of LARC patients, reduce treatment related side effects, and improve patient survival benefits. Conclusions Neoadjuvant therapy is the standard treatment strategy for LARC, and the exploration of neoadjuvant treatment models is expected to further improve treatment effectiveness, reduce toxic side effects, and improve survival prognosis. By combining tumor molecular biology indicators to identify and screen beneficiaries, it is expected to become an important direction for future research.