Colorectal cancer (CRC), a malignancy originating in the colon or rectum, has seen significant progress in treatment outcomes due to advances in therapeutic strategies. Organoids, as a cutting-edge research tool, have emerged as a transformative platform for understanding CRC mechanisms and optimizing personalized treatment approaches. We systematically review the traditional and new methodologies for establishing colorectal cancer organoids and the co-culture systems. Furthermore, we explore the utility of colorectal cancer organoids in drug screening, therapeutic development, and fundamental cancer research. While the integration of organoid technology into clinical practice holds great promise for personalized therapy, several technical and translational challenges remain to be addressed. The continued refinement and application of this technology are expected to deepen our understanding of CRC biology and accelerate the development of targeted therapeutic strategies, ultimately reshaping the landscape of cancer treatment.