There are internationally recognized indicators for assessing the early and late stage of gastrointestinal tumors. Gastrointestinal cancer and gastrointestinal mesenchymal tumors, endocrine tumors and other assessment indicators are not the same. When evaluating gastrointestinal cancer, the size of the mass is not included in these indicators, and the depth of the mass is the key indicator. As shown in the figure below, the colon tumor is only 1CM in size, and it looks like an ordinary polyp under colonoscopy, and most polyps of this size are not yet cancerous. However, based on our precise preoperative evaluation, this patient could not be resected endoscopically. After laparoscopic surgical resection, pathology also confirmed that the small tumor in this case had reached the muscularis propria, and a lymph node with metastasis was also found. Compare with my previous article “Rectal choriocapillaris adenoma not only to preserve the anus, but also to preserve the function”, the treatment of gastrointestinal tumors should be surgical, or can be endoscopically resected? Precise preoperative examination is very important in the planning process. The depth of tumor development is important in determining the expected outcome, but it is not the only indicator. For locally progressive tumors, that is, without distant metastases, the outcome can also be relatively good as long as the tumor lesion can be safely and completely removed. For example, as shown in the figure below, it is a case of progressive gastric cancer, with a nearly 7CM ulcer visible from the stomach cavity, which has entered the pancreas at the back of the stomach, and the mass has encircled the splenic blood vessels, forming a huge left upper abdominal mass, and the patient is ready to give up the treatment. After careful preoperative examination, we found that he was fortunate to have no obvious peritoneal cavity implantation metastasis, liver and lung metastasis. Therefore, we chose laparoscopy, and after a small hole was observed to confirm that there was no peritoneal implantation, we performed open surgery, starting from outside the tumor, and resected the entire left upper abdominal organs, including the entire stomach, most of the pancreas, and the spleen, and confirmed that the tumor had infringed on the pancreas at a very deep level by pathologic examination, but there was no metastasis of the more than 40 peripheral lymph nodes that had been cleared out of the tumor. Postoperative confirmation of stage T4bN0M0 is indeed a case that should not be abandoned.