本文系统阐述基于"肿瘤是全身性疾病"理念的超级微创手术(SMIS)在消化管道癌(GIC)中的整合治疗模式。SMIS的根本革新在于将治疗目标从传统器官切除转变为在病灶清除与器官功能保全，其理论基础在于将实体肿瘤视为由"肿瘤微球体"构成的异常器官集合体，治疗目标应是对该集合体的精准清除。对于早期GIC，通过精准评估筛选出转移低危患者，应用超级微创非全层或全层切除术等技术，可实现局部根治与器官保留。对于进展期GIC，治疗逻辑发生转变，通过新辅助治疗实现肿瘤退缩与全身控制后，再利用SMIS技术清除残余的耐药病灶，以巩固疗效、防止复发。这一分阶段、个体化的SMIS体系标志着GIC治疗从传统根治性切除向精准功能保全的重要转变。未来需进一步突破淋巴结精准清扫、多模态疗效评估等技术瓶颈，推动SMIS从局部治疗向区域性疾病控制的纵深发展，最终实现肿瘤学安全与生活质量的双重优化。

This review systematically elucidates the integrated treatment paradigm of Super Minimally Invasive Surgery (SMIS) for Gastrointestinal Cancer (GIC) based on the concept that "cancer is a systemic disease". The fundamental innovation of SMIS lies in shifting the treatment goal from traditional organ resection to lesion clearance with preservation of organ function, which is grounded in the reconceptualization of solid tumors as an aberrant organ composed of "tumor micro-spheroids". For early-stage GIC, precise patient stratification enables the identification of individuals at low risk of metastasis, allowing the application of SMIS techniques such as non-full-thickness or full-thickness resection to achieve local cure and organ preservation.In advanced GIC, the therapeutic rationale transforms: following tumor downstaging and systemic control via neoadjuvant therapy, SMIS is employed to eradicate residual drug-resistant lesions, thereby consolidating efficacy and preventing recurrence.This staged and individualized SMIS framework marks a significant transition in GIC management from traditional radical resection toward precise functional preservation.Future efforts should focus on overcoming technical bottlenecks such as precise lymph node dissection and multimodal efficacy evaluation, shifting the paradigm of lymph node management from "anatomic dissection" to "immunomodulation of the metastatic niche", promoting the evolution of SMIS from local treatment to comprehensive regional disease control, and ultimately achieving the dual optimization of oncological safety and quality of life.