精准肿瘤学通常指的是分子指导下对癌症进行治疗的方法。不太被重视但同样至关重要的是分子鉴定可手术切除的患者中最有可能从围手术期药物中受益的患者，并对这些药物进行精确选择。我们将这个理念称为精准围手术期治疗。在过去的几年里，关于局部消化道癌肿患者应用精准围手术期方法的临床试验和实践不断扩大。在这里，我们总结了该领域的现状，并突出了未来创新的领域。我们使用PubMed数据库回顾了英文发表的2017至2023年的文章。我们使用了“辅助治疗”、“围手术期治疗”、“新辅助治疗”和“精准医学”等关键词搜索了各种类型的消化道恶性肿瘤。有关正在进行的临床试验的信息是通过ClinicalTrials.gov于2023年1月获得的。概念，如通过循环肿瘤DNA检测最小残留病和围手术期免疫疗法替代化疗用于错配修复缺陷疾病，可能会在特定人群中减少毒性并改善长期预后。对转移性疾病显示活性的分子靶向药物在可治愈状态下也具有潜力。该领域目前仍在发展中，但新出现的数据显示了早期的潜力。我们对于正在进行的研究工作会越来越多地为可手术切除的消化道恶性肿瘤患者带来精准围手术期治疗感到乐观。

The term precision oncology typically refers to molecularly guided therapies against cancer. Less appreciated but also critically important is molecular identification of patients with resectable disease who are most likely to benefit from perioperative drugs, and tailored selection of such drugs. We call this idea precision perioperative therapy. Over the past several years, use of precision perioperative approaches for patients with localized GI cancers has expanded in clinical trials and practice. Here, we summarize the status of the field and highlight areas of future innovation.Using PubMed, we reviewed articles published from 2017 to 2023 in English. We used search terms "adjuvant," "perioperative," "neoadjuvant," and "precision medicine" for various types of GI malignancies. Information about ongoing clinical trials was accessed through ClinicalTrials.gov, accessed January 2023.Paradigms such as minimal residual disease detection via circulating tumor DNA and perioperative immunotherapy in lieu of chemotherapy for mismatch repair-deficient disease may lead to reduced toxicity and improved long-term outcomes in select populations. Molecularly targeted drugs that have shown activity against metastatic disease may also hold promise in the curable setting.The field is very much in development, but emerging data demonstrate early promise. We are optimistic that ongoing research efforts will increasingly bring precision perioperative therapy to patients with resectable GI malignancies.