Liu××, male, 65 years old. He was diagnosed with “gastrointestinal mesenchymal tumor with widespread abdominal dissemination and metastasis” by pathological diagnosis of mass puncture in February 2008. In March 2008, he started oral targeted therapy with Imatinib. The patient started treatment with good results until March 2009, when the tumor resistance was found to have progressed, and after increasing the drug dose, the patient received adriamycin-based chemotherapy plus oral “Imatinib” in an outside hospital, and the tumor continued to grow, and ascites gradually increased. The patient was admitted to the hospital in November 2009 and requested surgery. On admission, he was found to be malignant, with an ECOG score of 3-4. The abdomen was significantly enlarged, with a large amount of ascites and multiple masses were found in the abdomen. The patient strongly requested surgery, believing that surgery was the last hope for survival and that he would have no regrets if the outcome of surgery was poor, and even made a will before surgery. After discussion within the department, it was concluded that if the patient could tolerate the tumor reduction surgery, strive for complete removal of the tumor by the naked eye or remove most of the drug-resistant tumor foci, reduce the patient’s tumor load, and then replace the targeted drug therapy after surgery, the patient should be able to benefit to the greatest extent. So, on December 3, 2009, a dissection was performed under endotracheal anesthesia. Prof. Wenhua Zhan and Dr. Xinhua Zhang operated. Since the patient had an advanced tumor and was malignant, anesthesia and surgery were extremely risky. The attending professors tried to minimize the operation time and blood loss of the patient. In general, even if gastrointestinal mesenchymal tumors recur or metastasize, most of them have envelope and the tip is usually located in the luminal wall of the gastrointestinal tract, so the surgery is not very difficult. However, intraoperatively, the patient’s abdominal pelvic cavity was covered with tumors ranging from 1 cm to 20 cm in diameter and hundreds of them, combined with a large amount of hemorrhagic ascites. The patient had extensive metastatic mesenchymal tumor with multiple drug-resistant progression, active tumor growth, rich blood supply, and infiltration and fusion of metastatic tumors with extensive basal attachment to the peritoneum and mesentery of the abdominopelvic cavity; moreover, the patient’s malignant state also led to poor coagulation function and extensive bleeding from the wound surface during tumor debridement. Especially in the right lower abdomen where the tumors were most concentrated, the tumors were fused and extended to the pelvic cavity, and nearly 100 tumors of different sizes infiltrated the bladder and rectum in pieces. During the operation, the tumor envelope was peeled off from the right lower abdomen downward, because the tumor envelope was not obvious in the pelvic cavity, the boundary between tumor tissue and normal pelvic peritoneum was not clear, and some of the peeled surface formed tumor bleeding, the tumor tissue was brittle, and it was extremely difficult to stop bleeding, and the pelvic cavity was bleeding fiercely. With the full support of anesthesia, the chief surgeon was not afraid to use gauze pads to control the bleeding, and then opened the peritoneum on both sides of the pelvic wall to reveal the bilateral ureters to avoid accidental injury; then carefully and quickly identified the boundary between tumor and normal peritoneum from top to bottom, completely peeled off the tumor, and timely sutured the wound to reduce bleeding. After unremitting efforts, we finally completed this case of extremely risky and difficult metastatic gastrointestinal mesenchymal tumor reduction surgery. Postoperatively, the patient was discharged 12 days after surgery with no surgery-related complications after supportive treatment. The patient was replaced with targeted drug therapy postoperatively.