For patients with low local advanced rectal cancer who have achieved complete clinical response after preoperative neoadjuvant therapy, it is recommended to watch and wait (W&W) for treatment strategy, so as to achieve the purpose of organ preservation. However, only some patients are suitable for this treatment strategy, and there are still many difficult decisions in the implementation process. This article reviews the focus issues in neoadjuvant chemoradiotherapy strategy for low rectal cancer, such as how to accurately judge the clinical complete remission rate, how to increase the clinical complete remission rate, how to predict the clinical remission rate, how to deal with the tumor after local regeneration, whether it will increase distant metastasis, and how to deal with the poor effect of new adjuvant therapy, so as to provide reference for the decision-making of organ conserving therapy for rectal cancer.