First of all, the prognosis of stage 2 rectal cancer is good. stage 2 is divided into two subtypes, 2A (T3N0) and 2B (T4N0). Whether or not to treat stage 2 rectal cancer with chemotherapy depends on whether there are high-risk factors. High-risk factors include: hypofractionation, preoperative obstruction or perforation, vascular thrombosis, nerve invasion, and less than 12 lymph node dissections. Postoperative adjuvant chemotherapy is recommended for stage 2 combined with high-risk factors. However, the adjuvant chemotherapy regimen should be combined with microsatellite stability status. In case of high microsatellite instability (MSI-H), adjuvant chemotherapy (T3) or combination chemotherapy (T4 with high-risk factors), i.e. intravenous chemotherapy combined with oral chemotherapy, is not required. In case of microsatellite stability, single agent oral capecitabine chemotherapy is available. Therefore, if there are no high-risk factors in stage 2, chemotherapy can be left alone and has little impact on prognosis. However, regular review is recommended, because stage 2 bowel cancer also has the risk of recurrence, just a lower risk than stage 3 bowel cancer. If there are high-risk factors, chemotherapy is still recommended, at least single-agent oral chemotherapy, which has less side effects and can play a role in reducing the risk of recurrence at the same time.