To date, surgery remains the mainstay of treatment for a significant proportion of malignant tumors. Both patients and doctors must have a correct understanding of surgery, which is the basic premise for realizing the value of surgery. As we all know, tumor is essentially a systemic disease, which cannot be cured with a scalpel, nor can surgery fundamentally prevent the recurrence of tumor. However, it is undeniable that proper surgical resection can largely delay tumor recurrence and improve the survival time of patients. For choosing surgery, the first thing to consider is the necessity and possibility. For a widely spread, systemic metastasis, with the help of other radiotherapy drugs can not control the lesion, even if the highly skilled surgeon can not help. At this point, we can only face the reality and use palliative care: nutritional support and symptomatic management. Even if the extent of some tumors is relatively limited and we believe that they can be completely removed, but the patient’s general condition is poor, it should be carefully considered. It is important to understand that surgery is on the one hand a treatment of the disease, and on the other hand a trauma and a blow to the body, and not every patient can withstand this “test”. When we consider that surgery is possible after a detailed and thorough examination and evaluation, we are faced with the following two problems. We have to face the following two questions: first, what surgical plan can remove the tumor safely and completely (clean pathological margins); second, after the tumor is removed, can we try to preserve and repair the function and even the shape of the organ. The purpose of the former is to achieve oncologic cure, reduce tumor recurrence, and prolong patient life. And the purpose of the latter is to improve the organ dysfunction caused by tumor and surgical injury and to improve the quality of patient’s survival. Let’s talk about the former first. To completely remove the tumor is actually not simple. Here we have to talk about a principle of resection, the so-called en bloc resection (en bloc resection), which simply means to draw a safe boundary to ensure that the margins of the cut are clean and there is no tumor remaining in the residual tissues, and then the tumor is removed along this boundary. However, this type of surgery is suitable for any part of the body, such as tumors at the base of the skull. Due to the limited field of view, it is often necessary to take out the tumor tissue in several stages in order to finally remove all of the tumor. This type of surgery is not technically called a complete resection, but rather a total resection. This approach has the potential for tumor cell residue or implantation and is generally recommended to be used sparingly. However, nowadays we often use endoscopic surgery, which greatly reduces the damage despite the risk of residue, and the combination of radiotherapy and chemotherapy after the surgery has a very good therapeutic effect. In addition, we know that tumors often have regional lymph node metastasis in addition to the primary foci, which is one of the main factors for tumor recurrence and poor prognosis. It is one of the main factors of tumor recurrence and poor prognosis. Therefore, when removing the primary tumor, the metastatic lymph nodes must be removed together. If the tumor primary focus and metastatic lymph nodes are very close to each other, the primary focus and lymph nodes should be resected together as much as possible, which is called combined radical surgery. Some people also call it columnar resection, which means that the interval between the primary focus and the metastatic area of lymph nodes should be opened up a piece to be resected. For example, mandibular or tongue cancer, which is closely related to the floor of mouth, the general surgical approach is to resect the primary tumor, the tissue of the floor of mouth, and the cervical lymph nodes in one piece, and leave a defect through the oral cavity and the neck after the resection. Due to the traumatic nature of the surgery, “prophylactic” lymph node dissection is not recommended for those without signs of lymph node metastasis. For cases where the primary focus and metastatic lymph nodes are far away from each other, it is difficult to use this method, and generally, segmental resection is needed: i.e., separate resection of cervical lymph nodes and primary focus. This is often the case for the surgical treatment of laryngeal cancer. Here I would like to mention that for tumors in the maxillary region, lymph node metastases are mainly located in the pterygopalatine fossa, buccal region, etc. Careful consideration should be given to whether to do a dissection of lymph nodes in the distant neck. Generally the possibility of metastasis to submandibular or other parts of the neck is unlikely, and the significance of cervical lymph node dissection for maxillary sinus cancer is questionable. Next I would like to talk about another issue, that is, defect repair and organ function reconstruction after surgical resection. As we all know, it is usually easy to destroy something, but it is often difficult to repair something. So in this sense, surgical repair requires more skill on the part of the surgeon. A qualified surgeon should have a holistic concept of treatment and comprehensive medical knowledge, such as the pathology of tumors, radiotherapy, and imaging knowledge. On top of that, he has to have solid basic surgical skills, as well as certain cosmetic knowledge and very good repair and reconstruction skills. For example, the cavitation defect in the floor of the mouth just mentioned must have a large piece of tissue to repair. We generally use composite autologous tissue with blood vessels to repair, and the key technique is vascular anastomosis. It requires a high level of operating skill from the surgeon, who must be trained continuously over a long period of time to reach a high level. In addition to this, a mature perioperative management program, good nursing care, and the ability to respond to emergency repair failures are required to achieve true success.