The first one was a rectal adenoma, 7 cm from the anus and 2.5 cm in size. The surgery went relatively smoothly. After the surgery, there was no time for lunch and the other surgery was ready in the other operating room. I brushed my hands to sterilize them directly. This surgery for rectal cancer was more complicated than expected. The patient was a male in his 40s with rectal cancer with obstruction, and he visited a provincial oncology hospital outside the hospital. Later, he was referred to my clinic by a local doctor. The patient’s condition was advanced, with cancer of the upper rectum, invading the whole circumference, leading to narrowing of the intestinal lumen and difficulty in defecation. At the same time, the patient had multiple liver metastases. After joint consultation of multiple departments, the primary lesion was removed surgically first, and the subsequent liver metastases were treated with radiofrequency ablation and systemic chemotherapy. After preoperative preparation, the surgery started at noon today. The patient’s preoperative CT film suggested that the upper rectum was occupied, the intestinal wall was thickened, and the mesenteric lymph nodes could be metastasized. However, the intraoperative exploration revealed that it was much more complicated than expected. The cancerous nodes in the upper mesentery of the tumor fused with each other and stuck together with the iliac vessels (vessels supplying the lower limbs and pelvic organs) and the left ureter, which could damage the ureter with a slight inadvertence during the operation and lead to urinary leakage or hemorrhage that was difficult to control intraoperatively. During the operation, I suddenly realized that if it was a general rectal cancer resection, the treatment would not be refused in the provincial oncology hospital. The assistant on the same table suggested me to give up the operation and inform the patient’s family of his condition. I understood that there was nothing wrong to do so, and it was the safest for doctors, especially in the current medical environment. However, I thought about the fact that the patient had come thousands of miles for treatment, and if I gave up, the patient would soon not be able to pass stool, while the local tumor progressed rapidly and life expectancy was shortened, and if every effort was made to remove the primary focus, while the liver metastases were relatively small, RF eradication was very likely. The patient was very young and life expectancy could be significantly prolonged. At the same time, the patient’s family’s trust in me before surgery also played a big role at this moment, so I decided to strive for complete resection as long as there was a ray of possibility. Now that I had decided to do it, I told myself and my assistant to be quiet and separate slowly. Usually, such a surgery is over within 2 hours even if the laparoscopic minimally invasive surgery. The biggest concern of rectal cancer surgery is damage to the ureter and uncontrollable hemorrhage, and this patient’s lesion was very severely developed locally, with close adhesions to the left ureter and multiple lymphatic and cancerous nodes around the mesenteric vessels. When separating the ureter, sometimes the ureter was separated by electric knife with a slapdash touch, sometimes it was advanced by ultrasonic knife point by point, and when it was closest to the ureter, it was sculpted little by little with a small knife, and the ureter was separated at the distance of 3cm adhesion at the entrance of the pelvis for a full 30 minutes, and finally the ureter was separated completely, while ensuring the safety of the ureter. I felt a little bit more comforted and thought that it was a big step forward from complete removal of the tumor and metastases. The next step is to separate the level of tumor and iliac vessels. In common radical surgery for rectal cancer, it is relatively easy to separate and resect in the correct anatomical level, but once the tumor invades or local lymph node metastasis, it will lead to the disappearance of normal anatomical level, in this case, solid anatomical knowledge, firm psychological quality and good surgical skills are important to ensure the safe operation. With each step of separation, the alignment of important vessels and nerves was repeatedly observed, and the resection continued to advance while ensuring that there would be no collateral damage. But after the last cut to separate the metastatic lymph nodes from the blood vessels, the heavy stone in my heart finally fell to the ground. The rest of the surgical steps, including separation of the naked intestinal wall, dissection of the intestinal wall, and reconstruction of the GI anastomosis, were completed quickly. Finally, after completing the main surgical steps, the abdominal and pelvic cavities were flushed with a large amount of saline, and each area was carefully checked for any blood leakage from the trauma and any collateral damage, and after ensuring that there were no problems, a drainage tube was placed to end the surgery. After the operation, I showed the resected intestinal tumor to the patient’s family and told them that the operation was successful and it was good to be assured. During the operation, I was very focused and quick in thinking, and I did not feel fatigue or hunger at all. After the operation, I suddenly felt dizzy, weak and hungry. After returning to the department and dealing with a few waiting patients, I didn’t want to move at all, so I ate a cookie, drank a can of Red Bull, rested for ten minutes and then, after briefly sorting out tomorrow’s events, sat in front of the computer and continued to answer online patients’ questions. Then I typed the words above. It’s a difficult, tiring procedure, taking a lot of risks, and if something goes seriously wrong, it can have serious implications for one’s career. Many doctors in training say that in this case in our hospital, they must give up. But at this moment, I am very much at peace inside. It is not that I have successfully completed a complicated surgery, nor am I satisfied with the compliments of other doctors, but I just feel that I can afford the trust of my patients and families. If in the face of difficulties, are clear-eyed and choose the safest treatment plan for themselves, but what about the interests of patients.