Neoadjuvant treatment for colorectal cancer has evolved significantly, with a focus on improving local disease control and reducing systemic relapses. Short-course radiotherapy (SCRT) and long-course chemoradiotherapy (CRT) are established in rectal cancer, but total neoadjuvant therapy (TNT) offers advantages in local response and systemic relapse reduction. Non-operative management (NOM) is increasingly preferred for patients with clinical complete responses but may affect functional outcomes. Neoadjuvant chemotherapy may benefit locally advanced colon cancer with proficient mismatch repair (pMMR), though patient selection is challenging. Neoadjuvant immunotherapy in mismatch repair-deficient (dMMR) cancers is changing treatment paradigms. Neoadjuvant therapy aims to reduce surgical complexity and improve locoregional control. It is indicated for locally advanced tumors, particularly those with high-risk features like extramural venous invasion (EMVI) or threatened mesorectal fascia (MRF). CRT and TNT are common modalities, with TNT showing better pCR rates and reduced distant metastases. However, CRT may have slightly better local control. TNT is associated with improved pCR and reduced systemic relapses but may have higher local recurrence rates in some cases. NOM is considered for patients with cCR or near-complete response, offering organ preservation and improved quality of life. However, local tumor regrowth (LTR) is a concern, with salvageable options like completion TME or local excision (LE). Functional outcomes of NOM are generally better than TME, but there are risks of postoperative anxiety and functional impairment. In colon cancer, neoadjuvant therapy is less established, with upfront surgery as the standard. However, neoadjuvant chemotherapy may benefit high-risk patients, particularly those with pMMR, though evidence is limited. Trials like PRODIGE 22 and FOxTROT show potential benefits of neoadjuvant chemotherapy, though outcomes vary. MMR status influences treatment response, with pMMR cancers benefiting more from neoadjuvant therapy. Overall, neoadjuvant treatments for colorectal cancer continue to evolve, requiring careful consideration of patient factors, treatment modalities, and long-term outcomes. This review highlights current guidelines and recent developments in neoadjuvant therapy for colon and rectal cancers.Neoadjuvant treatment for colorectal cancer has evolved significantly, with a focus on improving local disease control and reducing systemic relapses. Short-course radiotherapy (SCRT) and long-course chemoradiotherapy (CRT) are established in rectal cancer, but total neoadjuvant therapy (TNT) offers advantages in local response and systemic relapse reduction. Non-operative management (NOM) is increasingly preferred for patients with clinical complete responses but may affect functional outcomes. Neoadjuvant chemotherapy may benefit locally advanced colon cancer with proficient mismatch repair (pMMR), though patient selection is challenging. Neoadjuvant immunotherapy in mismatch repair-deficient (dMMR) cancers is changing treatment paradigms. Neoadjuvant therapy aims to reduce surgical complexity and improve locoregional control. It is indicated for locally advanced tumors, particularly those with high-risk features like extramural venous invasion (EMVI) or threatened mesorectal fascia (MRF). CRT and TNT are common modalities, with TNT showing better pCR rates and reduced distant metastases. However, CRT may have slightly better local control. TNT is associated with improved pCR and reduced systemic relapses but may have higher local recurrence rates in some cases. NOM is considered for patients with cCR or near-complete response, offering organ preservation and improved quality of life. However, local tumor regrowth (LTR) is a concern, with salvageable options like completion TME or local excision (LE). Functional outcomes of NOM are generally better than TME, but there are risks of postoperative anxiety and functional impairment. In colon cancer, neoadjuvant therapy is less established, with upfront surgery as the standard. However, neoadjuvant chemotherapy may benefit high-risk patients, particularly those with pMMR, though evidence is limited. Trials like PRODIGE 22 and FOxTROT show potential benefits of neoadjuvant chemotherapy, though outcomes vary. MMR status influences treatment response, with pMMR cancers benefiting more from neoadjuvant therapy. Overall, neoadjuvant treatments for colorectal cancer continue to evolve, requiring careful consideration of patient factors, treatment modalities, and long-term outcomes. This review highlights current guidelines and recent developments in neoadjuvant therapy for colon and rectal cancers.