This report describes the diagnosis and treatment of a 53-year-old male patient with locally advanced rectal cancer who underwent laparoscopic total mesorectal excision (TME) following neoadjuvant chemoradiotherapy. Laparoscopic radical resection for rectal cancer was performed 8 weeks after the completion of radiotherapy. The procedure adhered to the principles of total mesorectal excision, with complete dissection of the No. 253 lymph node group and preservation of the left colic artery. The bowel was transected 5 cm distal to the lower tumor margin, followed by end-to-end anastomosis reinforced with barbed suture. No protective stoma was created. The patient recovered uneventfully and was discharged. Postoperative pathology revealed ypT₂N₀M₀, with no lymphatic, vascular, or perineural invasion. This case suggests that neoadjuvant chemoradiotherapy can effectively achieve pathological downstaging in locally advanced rectal cancer, providing a reference for clinical decision-making.