Background <p>Despite advances in minimally invasive techniques and widespread adoption of Enhanced Recovery Programs (ERPs), rectal cancer surgery continues to pose significant challenges due to anatomical limitations, risks of complications, and the potential impact on bowel, urinary, and sexual function. These complexities underline the need for clearly defined, evidence-based key interventions to assess and ensure consistent, high-quality care across institutions. The aim of this study is to identify and summarize the evidence-based key interventions relevant to rectal cancer surgery.</p> Methods <p>A focused PubMed/MEDLINE search was performed to identify key interventions in care pathways for rectal cancer surgery. The list of key interventions extracted from the literature was presented to an expert panel who evaluated their importance and relevance in a one-round Delphi process.</p> Results <p>In total, 293 papers were screened on title and abstract for relevant information. Twelve papers were retained to identify the initial set of key interventions (n = 56). The list was narrowed to 39 by excluding duplicates and outdated key interventions. This list was commented on during a 1-round Delphi, and consensus was reached for 37 key interventions regarding surgical rectal cancer treatment.</p> Conclusion <p>We propose this list of 37 key interventions as a contemporary framework for assessing rectal cancer surgery.</p>