Abstract: In the surgical treatment of rectal cancer, the concept of enhanced recovery after surgery (ERAS) serves as a core strategy for improving the patient′s prognosis, with perioperative nutritional support being a key component. The optimization of ERAS pathways is of great significance in reducing postoperative complications and promoting the patient′s recovery. This article systematically reviewed the research progress in perioperative nutritional support pathways for rectal cancer under the ERAS concept in recent years, covering the current status and causes of malnutrition in patients with rectal cancer surgery, preoperative nutritional assessment and pre-rehabilitation strategies, as well as the staged management strategies ranging from oral nutritional supplements (ONS) and enteral nutrition (EN) to parenteral nutrition (PN). It also pointed out the limitations of existing decision-making processes and explored the integration of multimodal patient data using artificial intelligence (AI), aiming to achieve more accurate prediction of nutritional risks in the future and provide new insights for formulating individualized decision-making.