Every day, we will encounter patients who are anxiously waiting for surgery in our clinical work, and they desperately hope that the doctor can operate for them a day or even a few hours earlier. Undoubtedly, surgery is the main treatment for most malignant tumors today, but shouldn’t the tumor be removed on the operating table as soon as it is found? The answer is no. First of all, there are a few tumors that can be cured by chemotherapy and radiotherapy, such as nasopharyngeal carcinoma. For these tumors, surgery should be put in the second place. Moreover, surgery has its indications and contraindications, that is to say, not every tumor patient can receive surgical treatment, and in order to have surgery, they must meet the indications and no absolute contraindications. So, what kind of patients can receive surgical treatment? Generally speaking, tumor patients who meet the following three conditions can be operated: 1. The tumor can be completely removed: that is to say, the tumor has not invaded the surrounding important organs, or although it has invaded the surrounding important organs, it can be completely removed together with the surrounding organs by surgical means, that is to say, the local early stage cases. The reason why surgery is a better treatment than chemotherapy and radiotherapy is the ability to completely remove all tumor cells at once. If the tumor is not completely removed, the residual cancer cells will become a base for the cancer to attack again. During the recovery period after surgery, the patient’s health is very weak and the residual cancer cells will take advantage of this period to grow rapidly or even metastasize. For lung cancer, if the tumor does not invade the surrounding heart, large blood vessels, spine and other important organs that cannot be removed, then with the surgical skills of surgeons, the tumor can be completely cut clean. 2. No distant metastasis of tumor: that is, the tumor has not spread to other tissues or organs far from the primary organ with vascular system or lymphatic system. If the tumor has metastasized to distant organs, it means that the patient’s condition is no longer a local basic but a systemic disease, and the cancer cells have metastasized to the whole body with the vascular system or lymphatic system. At this time, the best treatment becomes systemic treatment such as chemotherapy or targeted therapy. This is a bit like what Bian Magpie said to Duke of Cai Huan, “The disease is in the coup d’état, which is reached by soup and iron; in the skin, which is reached by needle and stone; in the intestines and stomach, which is reached by fire; and in the bone marrow, which belongs to the Secretary, which is helpless. Now in the bone marrow, the minister is to no please also”, translation is “in the skin such a superficial place of the disease, is the power of ironing can be treated; in the skin of the disease, with the needle prick such a method can be cured; in the stomach and intestines of the disease, with the fire agent soup can be treated; but if the disease has been deep into the bone marrow that is the matter of the king of hell, medicine is no way of. The Marquis of Huan’s illness has now penetrated to the marrow of his bones, so I will no longer ask about it.” —— paraphrasing Bianchi: “If the cancer has metastasized to other organs of the body, surgical means can no longer intervene.” Take lung cancer as an example again: before lung cancer surgery, the doctor will check your head, bone, neck and abdomen, because these are the areas where lung cancer is most likely to metastasize, if no metastases are found in these places, then the hurdle of distant metastasis is considered passed. 3. The patient’s physical condition can tolerate the surgery: as we all know, the surgery itself can be a big blow to the patient, especially the large-scale surgery like open-chest and open-abdomen. Therefore, surgery, especially major surgery, also has very strict requirements for the patient’s physical condition, otherwise there is a risk that the surgery is done successfully, but the patient has a myocardial infarction, pulmonary embolism or cerebral infarction and other diseases, which is not worth the loss. Generally, the doctor will take a detailed medical history of the patient before the surgery, such as whether he/she has high blood pressure, diabetes or heart disease, and whether he/she has been diagnosed with heart attack or cerebral infarction. The doctor will prescribe a list of tests to evaluate your physical condition, such as ECG, echocardiogram, 24-hour electrocardiogram (Holter), brain CT/magnetic resonance imaging (MRI), vascular color ultrasound, and laboratory tests such as blood, urine, stool and biochemistry. Please understand when you are given a stack of checklists and have to run up and down the stairs for tests, it is for the sake of your surgery. If, after strict preoperative examination and evaluation, the doctor tells you: we can cut your tumor cleanly, the tumor is still confined to the body with no distant metastasis, and your body can bear the blow of surgery, then congratulations, you will be one of the lucky few patients who can receive surgery among all tumor patients, and your survival time after surgery will be much longer than those who cannot receive surgery. It is also important to mention that there may be some “preoperative adjuvant therapy” before surgery, such as preoperative chemotherapy or preoperative radiotherapy, which is recommended by doctors according to the patient’s specific condition, in order to kill any possible distant metastases before surgery, or to make the tumor smaller, so that the tumor that is difficult to be cut cleanly can be cut cleanly. This allows more patients to be treated surgically. If your doctor recommends “preoperative adjuvant therapy” based on your overall condition, please do not rush to surgery because the latest international research has shown that appropriate preoperative adjuvant therapy can improve the survival time of patients. Lastly, if your lung cancer can be treated surgically, you should do sufficient preparation work before surgery, because lung cancer surgery is a major surgery, and there may be many problems if you do not do it well. It is important to know that it has been at least six months to one year from the occurrence of lung cancer to the possible detection by today’s medical means, and a few days late surgery will not have much impact on the condition.