Gastrointestinal mesenchymal tumors are primarily treated with surgery, but with the beginning of the targeted era, targeted therapy is also a major treatment modality for gastrointestinal mesenchymal tumors. There is also a small group of patients with liver metastases that can be treated with radiofrequency or interventional therapy. Which patients with gastrointestinal mesenchymal tumors can be treated surgically? Surgical treatment is determined by the general condition of the patient and the stage of the tumor. Gastrointestinal mesenchymal tumors can be classified according to primary tumors and recurrent metastatic tumors. Patients with primary tumors also need to see if there are distant metastases, and patients who develop distant metastases are not suitable for surgical treatment. Recurrent metastatic gastrointestinal mesenchymal tumors are mainly treated with targeted therapy. If targeted therapy can bring the tumor under control, adjuvant surgery will be performed if R0 resection (i.e., complete resection without cancer cells at the surgical margins) can be obtained after physician evaluation. Can patients who cannot undergo surgery only receive targeted therapy? The first choice of treatment is targeted therapy. However, there are some patients who have resistance gene of targeted drugs and the targeted drugs are not effective for them, so they cannot receive targeted drug therapy. There are no better treatment options for this group of patients.