I happened to hear about a young patient who died 10 days after a thorough and “satisfactory” surgery for cancer at one of our nation’s best oncology hospitals. It gave me time to think about the destruction and repair of surgery. Indeed, surgery can remove tumors, but at the same time, it also traumatizes and destroys normal tissues and organs. Therefore, surgery is a “double-edged sword”. So, how to utilize the “double-edged sword” of surgery? In the case described earlier, we thought afterwards that although our surgery met the criteria for satisfactory surgery as described in the Guidelines, the result was that the patient did not benefit from the “satisfactory” standard surgery, but rather failed to withstand the trauma of the surgery, or failed to withstand the trauma of the surgery. However, the result is that the patient does not benefit from the “satisfactory” standard procedure, but rather does not survive the trauma of the procedure, or the devastating impact of the procedure. The key to this outcome is faulty surgical decision-making. So what are the factors that influence surgical decision-making? The surgeon’s philosophy is the dominant factor, or in the case mentioned above, the surgeon’s thinking might have been something like this. The patient was young, and according to the “guidelines”, the thoroughness of the first surgery was closely related to the patient’s prognosis. In order for the patient to have a longer life expectancy, the surgery had to remove the lesion as thoroughly as possible, and in order to completely remove the lesion, the normal tissues and organs in which the lesion had been planted had to be removed at the expense of the principles of surgical treatment. Therefore, the surgeon does not rest until all the lesions that do not meet the criteria have been removed. It is also because of the young age of the patient that the hurdle of surgery was survived and still not survived the hurdle of postoperative complications. Therefore, the patient’s tolerance has to be taken into account during surgery. In other words, the tumor is the target of the surgery, and the removal of the tumor is not the goal, but only a means to stop the progression of the disease and allow the patient to gradually return to the state before the disease. The knowledge of the surgeon is a key factor. The surgeon should at least know what kind of surgery is more appropriate for the patient, otherwise, the result will be the opposite. This is not difficult to understand. The skill of the surgeon is the determining factor, the implementation of the final surgical plan lies in the surgeon’s ability to do, confined to the surgeon’s skills. It can be seen that the surgeon’s philosophy is the direction, knowledge is the escort, and skill is the tool. If the direction is wrong, the farther away from the destination, the farther; only the right direction, and then choose the appropriate, safe transportation, in order to reach the destination with half the effort. In other words, the higher the skill, the more important the correct concept seems to be, once the direction of choice is wrong, highly skilled surgeons as off the “wild horse” extremely fast away from the target, difficult to stop!