Abstract: Objective To explore the efficacy and safety of imatinib mesylate as neoadjuvant treatment for rectal stromal tumors patients. Methods Forty cases of rectal stromal tumor patients were given imatinib mesylate tablets orally，400mg/d lasting for 6 months，and then the operation indication was assessed. According to the size and location of the tumor，patients were underwent local excision，rectal low anterior resection or abdominoperineal resection combined with rectal cancer treatment. Results By RECIST 1.1 criterion，3 cases got CR， 31 cases had PR， 4 cases got SD and 2 cases were of PD. The response rate（RR）was 85.0%, and the disease control（DCR） rate was 95.0%. By Choi criterion，3 cases got CR，28 cases had PR，7 cases got SD and 2 cases were of PD. RR was 77.5%， and DCR was 95.0%. R0 resection was performed in 38 cases. The 1-year survival rate was 100.0%，and 2-year survival rate was 95.0%. The incidence rate of mild edema was the highest （72.5%）， followed by leukopenia （47.5%）， and the other adverse effects included fatigue， abdominal pain and gastrointestinal reaction，which were tolerable. Conclusion Preoperative use of imatinib mesilate in rectal stromal tumors can expand the indications of operation，as well as raise R0 resection rate with stable efficacy and safety， and this neoadjuvant treatment can be used as individual treatment of rectal stromal tumors.