In clinical work, many patients and family members often ask doctors some questions at the beginning of tumor diagnosis, and a representative one is “Doctor, is it okay to do surgery only? “Do I have to have chemotherapy after surgery?” “Do I have to have radiotherapy and chemotherapy before surgery?” Yes, why can’t a single treatment solve the problem? I would like to chat with you for a few minutes. Li Chengpeng, Department of Hepatobiliary and Pancreatic Surgery, Peking University Cancer Hospital, from the perspective of historical development, indeed surgery is the first treatment for tumor. Breast cancer was mentioned in the ancient Egyptian literature in 2500 BC. By the fourth century B.C., Hippocrates, an ancient Greek medical doctor, described breast cancer in detail in his writings, and there were surgeons who tried to treat breast cancer through surgical excision in the ancient Greek period. For example, radiation therapy for tumors only emerged gradually after Roentgen’s discovery of X-rays and Madame Curie’s discovery of radium, while chemotherapy for tumors is even more recent, originating from the leak of the chemical weapon mustard gas at the end of World War II. The current hot tumor targeted therapy has been born only for more than 20 years. Although surgery was the earliest, radiation therapy, chemotherapy and targeted therapy are all minor characters, but in fact, the improvement of tumor treatment level in recent decades is mainly inseparable from these minor characters, as the big brother of surgery plays a more limited role in it. Taking breast cancer as an example, Dr. Halsted, a famous surgeon from Johns Hopkins University Hospital in the late 19th century, invented Halsted radical surgery. Dr. Halsted was very smart and diligent, and after research, he came to the conclusion that the development pattern of breast cancer is first local infiltration of tumor cells, then metastasis along the lymphatic tract, and finally hematogenous dissemination, and if the tumor and regional lymph nodes can be completely removed when distant metastasis occurs, it may be cured. If the tumor and the regional lymph nodes can be completely removed before the distant metastasis occurs, it can be cured. The emergence of Halsted’s radical surgery for breast cancer is indeed a great innovation in the development of surgery and has changed the history of tumor treatment. However, after decades of observation, many European and American surgeons again observed that in addition to the regional lymph nodes discovered by Dr. Halsted, there were also lymph node metastases in the second and third stations, so the 1950s came into being with the expanded radical surgery for breast cancer, which had a wider surgical excision but increased post-surgical complications and mortality, but did not have the effect of significantly improving the cure rate. Isn’t the bigger the surgery, the better? Through continuous research and pondering, doctors gradually came to realize that cancer is not a localized disease, but often a systemic disease. The pursuit of enlarged local excision alone, ignoring the systemic development of the tumor, does not benefit the patient, but may increase the suffering. For example, Halsted’s radical mastectomy for breast cancer routinely requires resection of the pectoralis major and pectoralis minor muscles, the removal of which not only brings changes to the appearance of the patient’s chest wall, but also causes certain problems in the functional movement of the limbs. In the 1960s, a modified radical surgery for breast cancer was introduced. It is the most standard procedure in breast surgery in the last half century. Although modified radical surgery does not need to sacrifice the pectoralis major and pectoralis minor muscles, the patient’s side of the breast and axillary lymph nodes still have to be cut off. How to change this problem? In the last 30 years, with the advancement of radiotherapy and chemotherapy techniques, breast-conserving surgery and surgery that dispenses with axillary lymph node dissection have emerged. In other words, depending on the stage of the patient’s disease, through preoperative or postoperative radiotherapy, it is possible that not all of the breast needs to be removed, but only part of it, and not all of the axillary lymph nodes need to be completely cleared, and many patients do not need lymph node clearance. This is undoubtedly a great benefit for women who are unfortunate enough to have breast cancer. Throughout the development of breast cancer treatment, we see that breast cancer treatment has gone through a process from local excision – radical surgery – expanded radical surgery – modified radical surgery (reduced radical surgery) – preserved breast, which is actually a process of surgery from small – big – bigger – small – smaller – even smaller. One of the reasons why there is such a process is that with the progress of science and technology, doctors have gradually improved their understanding of the biological behavior of tumors and realized that tumor is not a local disease, but a systemic disease, and single treatment means are limited. The second is the rapid development of the level of treatment means other than surgery, such as radiotherapy and chemotherapy, which has promoted the improvement of tumor treatment effect. In today’s tumor treatment, surgeons are not fighting alone, and the era of surgeons “walking with swords” is over. Immunotherapy and gene therapy are also new tools that have emerged in recent years. In layman’s terms, for surgical patients, the comprehensive treatment often includes postoperative treatment and preoperative treatment, etc. First, what is postoperative treatment? Postoperative treatment refers to chemotherapy, endocrine therapy, targeted therapy, etc. after radical surgery. Surgery can reduce the tumor load in the body and improve the effect of chemotherapy, while chemotherapy helps to kill the residual tumor cells and improve the cure rate. What kind of patients need post-operative adjuvant therapy? Taking GI tumors as an example, they are often those patients with late stage on tumor pathology, deep tumor infiltration, or combined with regional lymph node metastasis. Secondly, what is preoperative treatment? Pre-operative treatment is for patients who are found to have large local tumors or regional metastases at the time of diagnosis, and need to confine the tumors through pre-operative chemotherapy, radiotherapy and targeted therapy before surgery, or convert some cases with pre-operative tumors that are too large for surgery into cases that can be surgically removed before surgery. As an example, at present, patients with low and middle-grade rectal cancer who have late local staging or lymph node metastasis need to receive radiotherapy + chemotherapy before surgery. Through this means, the staging of tumor is reduced and the recurrence rate of rectal cancer after surgery is reduced. Finally, to quote the words of Sun Yan, a famous oncologist in China, the comprehensive treatment of tumor is “to apply the existing means in a rational and planned manner to improve the cure rate and patient’s quality of life according to the patient’s body condition, especially the immune function, the site of tumor, pathological type and heterogeneity, gene expression and receptor situation and development tendency. “. No matter what the comprehensive treatment contains, the ultimate goal of these treatments is to improve the cure rate of tumors and the quality of life of patients, which is the goal and dream of every oncologist.