With the emergency of biological technology, gene sequencing and big data analysis tools, medical treatment entered the era of precision medical. As a result of the progress and development of clinical imaging techniques, the acquisition of clinical and personal biological data has made personalized treatment possible. The era of precision medicine has brought new horizon for diagnosis and treatment of rectal cancer. Different treatment should be taken into account in a different location in rectal cancer. Surgery is still considered as the principal treatment for rectal cancer, however, there is long-standing controversy as to whether LPN metastases represent systemic or localized disease. Based on the promotion of standard treatment for rectal cancer, we must share following views that the different subjects should join forces to improve selection criteria for LPND, avoid unnecessary injury, prevent over treatment, and ultimately aim to propose the precision medicine program in the future for patients with low rectal cancer.