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Can Tho City, the central hub of the Mekong Delta, is characterized by a distinctive “water-based urban identity” shaped by the Hau River, canals, and orchard gardens. Amid rapid urbanization and climate change, Can Tho’s urban landscape experiences multiple pressures, including flooding, riverbank erosion, reduction of green space, and the gradual loss of cultural identity. The study aims to analyze three main dimensions of Can Tho’s landscape: (i) natural – hydrological ecosystems and alluvial soil; (ii) built – urban morphology, infrastructure, and vernacular architecture; (iii) socio-cultural – a lifestyle closely tied to waterways. Grounded in landscape ecology theory and informed by international ecological urban models, the study proposes sustainable ecological orientations including conserving the water-based identity, enhancing blue–green infrastructure, managing flood and erosion risks, applying digital technologies, and fostering community participation, aiming to guide Can Tho towards becoming a resilient, climate-adaptive “water-based ecological city”.