When you have bowel cancer, patients and their families will be very anxious and the first thing that comes to mind is to find the best surgeon and rush to surgery. However, here I would like to say that rushing to surgery is not a rational choice for bowel cancer patients, and it is necessary to choose scientific treatment strategy based on the assessment results. I. Early stage bowel cancer may not need major surgery With the development of China’s economy and the improvement of people’s living standard, we are paying more and more attention to the intestinal health, and many patients with chronic intestinal symptoms or abnormal tumor markers will take the initiative to undergo colonoscopy, therefore, the proportion of patients who are detected with early stage bowel cancer or cancerous lesions of polyps is gradually increasing. Of course, whether it is early stage bowel cancer or not needs to be strictly defined according to the diagnostic criteria by performing pelvic nuclear magnetic and rectal ultrasound examinations. If early bowel cancer or polyp cancer is diagnosed, enteroscopic resection, transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) can be performed, and regular postoperative review is sufficient. For some patients with postoperative pathology suggesting residual tumor at the margin or high-risk pathology, remedial bowel resection can be performed via laparoscopic transabdominal resection (please refer to my article “When to perform remedial bowel resection after enteroscopic resection of colorectal polyps?) Please refer to my article “When to perform remedial bowel resection after colon polyp electrolysis? For bowel cancer patients without distant metastases such as liver and lung, surgery is the fundamental means to cure bowel cancer. However, for some bowel cancer patients, direct surgery may face a high risk of local recurrence. According to the current clinical practice guidelines for bowel cancer in patients, for rectal cancer with late local staging after preoperative nuclear magnetic evaluation, such as T3c or above, extra-mural vascular invasion (EMVI+), and suspicious positive margins around the predetermined surgical circumference, it is necessary to carry out preoperative radiotherapy, and then proceed to surgery when the tumor is downstaged. It has been shown that preoperative radiotherapy reduces the rate of postoperative local recurrence of rectal cancer by about 5% to 15% compared with rectal cancer patients who do not undergo preoperative radiotherapy. On the contrary, for these patients, if they take the risk of rushing to surgery, patients will face a high risk of local recurrence and distant metastasis after surgery. Thirdly, initial surgery is not recommended for advanced bowel cancer, and comprehensive treatment is an effective means of treatment. If the bowel cancer has distant metastasis such as liver, lung, bone, etc., and the preoperative staging belongs to the advanced stage, usually speaking, the surgery only removes the primary lesion of bowel cancer with little significance, and it cannot improve the patient’s survival, and it may reduce the immunity of the patient due to the trauma of the surgery, resulting in the violent spread of metastasis, and at the same time, the complications of the surgery may lead to systemic chemotherapy, resulting in the risk of local recurrence and distant metastasis. complications, resulting in effective means such as systemic chemotherapy cannot be implemented in time. For tumors with distant metastases, multidisciplinary comprehensive treatment is needed to prolong the survival time of patients. A part of patients who are sensitive to chemotherapy and targeted therapy drugs will have their metastatic foci shrunk or even disappeared through transformational therapy, and thus they may get the chance of radical treatment by surgery. For example, a patient with multiple liver metastases of colorectal cancer, after effective comprehensive treatment, the liver metastases may be significantly reduced, and if all the lesions can be completely resected through surgery, the 5-year survival rate can reach about 25%, while the median survival of untreated patients is not more than 1 year. To sum up, the treatment of intestinal cancer patients needs to be “tailored to the local conditions”, and the perfect evaluation before treatment is the key, and individualized treatment plan should be made for patients according to the stage of the tumor and the physical condition of the patients.