Rectal adenocarcinoma can be treated without surgery because current studies show that it is feasible for rectal adenocarcinoma to be treated without surgery, with simultaneous radiotherapy or chemotherapy, and with a watch-and-wait strategy if complete pathological remission can be achieved. In the course of close follow-up, if there is recurrence or progression, surgery is still needed. This strategy is more suitable for senior and older patients with more co-morbidities, such as coronary artery disease, hypertension, diabetes, etc. This strategy can be adopted if surgery is refused.