<p>In September 2025, version 3.0 of the German S3 guideline on colorectal cancer was published, representing the first comprehensive revision since 2019. The update goes far beyond a simple amendment and reflects the rapid progress in diagnostics und treatment of colorectal malignancies. In addition to a stronger intergration of molecular pathology and genotype-based therapeutic decision-making, the guideline places increased emphasis on patient-centred outcomes, including functional preservation, quality of life, rehabilitation, and survivorship. Newly introduced chapters on pathology, supportive care, and rehabilitation and tertiary prevention highlight this paradigm shift. Particularly in rectal cancer, differentiated stage- and risk-adapted pathways are presented, explicitly acknowledging organ-preserving as a valid option for selected patients. At the same time, requirements for preoperative imaging and multidisciplinary tumour board decision-making are further specified. Despite the high methodological quality and level of detail, several recommendations remain open to discussion, including reconstructive techniques, and the transferability of recommendations for rectal cancer therapy to specific tumour locations. Overall, the revised S3 guideline represents a major step towards a more individualized, interdisciplinary, and patient-focused management of colorectal cancer.</p>