Stomach cancer is still one of the major diseases that endanger the health of our people. Most of the gastric cancer patients in China are mainly in the middle and late stages, and most of them are concentrated in the vast rural areas, and surgery is the only possible cure. From the treatment of gastric cancer patients in recent years, I found that the surgical level of different hospitals in different regions and even different doctors in the same hospital varies, and the failure of many gastric cancer patients is often caused by ignoring small details. This article elaborates several basic issues that need to be paid attention to in the current gastric cancer surgery, hoping to arouse the vigilance of our colleagues. At present, it is believed that the local recurrence of gastric cancer after surgery is mostly caused by the residual cancer tissue during surgery. The absence of cancer in both cut edges should be the most basic requirement of any surgery for the purpose of radical treatment. Once the residue is left, it basically means the failure of radical surgery. During the exchange visits abroad, the author found that most hospitals abroad have pathology rooms in the operating room, which are specially used for freezing to check whether there is cancer residue in the surgical margins. This shows that they attach great importance to the complete absence of cancer in the cut edge! In recent years, with the increasing incidence of esophagogastric union cancer in China, we found that the number of patients with recurrence of proximal anastomosis cancer in outpatient clinics is also on the rise, which is closely related to the cancer residue in the proximal cutting edge during the first surgery. Therefore, intraoperative margin freezing should be routinely done for gastric cancer of the esophagogastric junction, especially when there is invasion of the esophagus. Generally speaking, when the gastric specimen is cut down, the first thing the surgeon should do is to open the specimen to observe whether the cut margin is sufficient, and additional resection should be done if it is not enough, which should be the basic habit of every surgeon, especially the gastrointestinal oncology surgeon. Otherwise, it would be tricky to wait until after anastomosis to examine the specimen and deal with it when suspicious residual cancer is found. And once the postoperative pathological examination reveals the residual cancer of cutting edge, the patient loses the best chance of cure. 2. Attention should be paid to the clearance of D2 lymph nodes, especially to ensure the complete clearance of the first station lymph nodes such as gastric lesser curvature In recent years, the dominance of D2 clearance for progressive gastric cancer has been gradually established. With the efforts of the Specialized Committee on Gastric Cancer of China Anti-Cancer Association, the promotion of D2 lymph node surgery in China has also achieved many results. However, while many units are gradually doing well in the second-stage lymph node dissection, we also find that people sometimes neglect the more important first-stage lymph node dissection. I have treated a patient in the outpatient clinic who had local recurrence 2 years after radical surgery for distal gastric cancer in an external hospital, with stage pT3N1M0. The surgical pathology showed no cancer in both margins, only 2 lymph nodes metastasis in the lesser curvature of the stomach. It can be speculated that the recurrence of this patient is related to the incomplete lymph node tissue clearance on the lesser curvature side of the first surgery. If D1 and D2 clearance surgery for progressive gastric cancer is still a little controversial in Europe and America, D1 lymph node clearance has been a worldwide consensus. This is because gastric cancer metastases mostly start from the first lymph node in the perigastric region, and complete lymph node dissection at this station is a prerequisite for successful gastric cancer surgery. At present, most gastric cancers are located in the lesser curvature of the stomach at the time of consultation, and among the perigastric lymph nodes, the lymph nodes on the side of the lesser curvature of the stomach are often the most prone to metastasis. Therefore, the author believes that for gastric cancer preoperatively diagnosed as progressive stage, regardless of whether the tumor is located proximally or distally, complete nudity of the lesser curvature side of the stomach should be ensured in order to completely clear its lymph nodes and its fibrous connective tissue, and if necessary, total resection of the lesser curvature can be performed. 3.Laparoscopic gastric cancer surgery should not be performed in one go In recent years, we may encounter patients with gastric cancer who have cancer implantation in the perforation orifice after laparoscopic surgery or abdominal metastasis soon after laparoscopic radical surgery in outpatient clinics. Laparoscopic surgery for gastric cancer started in Japan, and with the vigorous promotion of medical device companies, laparoscopic gastric cancer surgery in China is developing rapidly and has a great tendency to catch up with Korea and Japan. However, we should be soberly aware that, except for diagnostic exploration, the advantages of laparoscopic treatment are small incision and quick recovery in the near future. In terms of long-term survival rate and quality of life, which are the most important measures of gastric cancer surgery, lumpectomy gastric cancer surgery will not surpass open surgery. Today, surgeons in Korea, Japan, Europe and America are strictly grasping the indications for lumpectomy for gastric cancer, i.e., it is currently limited to early-stage gastric cancer. Laparoscopic surgery for progressive gastric cancer is strictly screened for patients and patient consent is strictly sought before it is performed in a small area of clinical trials. They believe that gastric cancer is a tumor that is very prone to abdominal implantation and metastasis, and once gastric cancer enters the progressive stage, especially when it breaks through the plasma membrane, laparoscopic surgery may lead to tumor dissemination. At present, laparoscopic gastric cancer surgery is carried out blindly in many regions of China, and there is a tendency to go up in a flurry, especially in those hospitals which do not have many cases of gastric cancer surgery each year and are not yet skilled in open D2 surgery, but they try to carry out laparoscopic gastric cancer resection “new technology” with certain difficulty directly to gain attention, which will ultimately damage the interests of patients. In the end, the interests of the majority of patients will be harmed. Since most of the gastric cancer patients in China have already invaded the plasma membrane by the time they are diagnosed, blindly performing laparoscopic surgery may cause the risk of spread of metastasis. We hope that the relevant authorities can implement a strict admission mechanism for laparoscopic gastric cancer surgery. In clinical practice, we often find that many doctors’ surgical operations do not look special, but their patients often have good outcomes. The reason for this is their reasonable treatment design, their deep understanding of the basic principles of surgery and strict adherence to details, as well as their love and responsibility to each and every patient. Because we all know that each patient has only one chance to have surgery.