The “sandwich” method is the first choice for the treatment of “locally advanced” gastrointestinal cancers. Scientific and systematic evaluation and correct staging before surgery are very important. Remember: qualitative diagnosis is important, and staging diagnosis is more important. Many patients with esophageal cancer, gastric cancer and rectal cancer are found to have obvious lymph node metastasis after enhanced CT of chest and upper abdomen and enhanced CT of pelvis or magnetic resonance imaging or ultrasound endoscopy. How to treat these patients scientifically? Is it immediate surgery? The answer is no. According to the latest international research progress, the best treatment mode for patients with locally advanced esophageal, gastric and rectal cancers with lymph node metastasis is to have chemotherapy or/and radiotherapy before surgery, followed by radical surgery, and then appropriate chemotherapy after surgery. This approach to the treatment of locally advanced gastrointestinal cancers is imaginatively called “sandwich” therapy. Such a comprehensive treatment model can improve the surgical resection rate, reduce the local recurrence rate and distant metastasis rate, and also improve the postoperative survival rate, prolong the patient’s survival time and increase the cure rate. This treatment mode has become a regular treatment mode in world famous cancer centers and “five major cancer hospitals” (Cancer Hospital of Academy of Medical Sciences, Beijing Cancer Hospital, Shanghai Cancer Hospital, Sun Yat-sen University Cancer Hospital and Tianjin Cancer Hospital) in China, especially for locally advanced rectal cancer, which is far more effective than traditional surgery alone or direct surgery. The effect is better. Second, clinical reality is often unsatisfactory, and many patients with locally advanced gastrointestinal cancer rush to surgery with regrettable results. However, unfortunately, in the clinical practice of many primary hospitals, general hospitals and even some specialized hospitals, it is often found that some patients with esophageal cancer, gastric cancer or rectal cancer are diagnosed with cancer by gastroscopy or colonoscopy and then everything is done. On the one hand, patients’ family members are eager to treat and lack of medical knowledge, so they are hastily admitted to surgery to seek surgery opportunities, some of them do not do in-depth and systematic comprehensive examination, but simply do a chest X-ray, abdominal ultrasound and other examinations, and then rush to perform surgery. On the other hand, some surgeons have old concept, aging knowledge, lack of overall thinking and comprehensive treatment consciousness, take the scalpel in their hands as the “only gold standard” for tumor treatment, think that as long as they can remove the tumor, the patient can survive for a long time, and take the simple “removal” of the tumor as the same as “cutting”. “This is the same as “cutting out” the tumor. In this way, patients or family members are eager to operate, and doctors also want to operate. Under the influence of such dual factors of your love and my wish, tragedy naturally plays out, and the result of surgery can be imagined. Due to the late preoperative staging, the patient often has the following two possible tragic outcomes: 1. The tumor is found to have metastasized during the surgery, and the surgery cannot achieve clean resection, so a simple palliative surgery is done, and some even close the abdominal cavity directly. 2. The surgery can barely achieve the removal of the tumor by the naked eye, and it is not easy to judge whether the tumor is clean or not, anyway, the patient did not die on the operation table or during the perioperative period, and the patient was treated with chemotherapy hastily after the surgery, and the patient recurred and metastasized soon after the surgery, and was transferred to internal medicine. Such non-standardized, unscientific, lack of overall consideration and full management of randomized treatment is quite common in many primary hospitals, general hospitals and even some specialty hospitals, which is worrying.