Background: Preoperative education is an important component of surgical cancer care that has been shown to impact surgical outcomes. However, the quality of education varies, especially among patients with low health literacy (HL), which is prevalent among states in the Deep South. Low HL patients experience worse surgical outcomes, and variation in preoperative education further increases the disparity gap for this vulnerable patient population. We aimed to characterize patient perspectives of preoperative education by HL level among gastrointestinal cancer patients in the Deep South. Methods: Surveys were administered to colorectal, pancreatic, and esophageal cancer survivors in Alabama and Mississippi. Eligible participants had stage 1-3 cancer, were within 5 years of diagnosis, and had surgery as part of their cancer care. Participants were also administered the BRIEF survey, which is a validated four question survey measuring HL level. Patients with a score of 17 or higher were categorized as having adequate HL, while a score of 16 or less were categorized as having low HL. Fisher Exact or Chi Square tests were performed to examine significant differences between patients with low and adequate HL. Results: Of 272 survey respondents, the mean age was 63.17 (±11.57) and 151 (55.5%) were women. 92 (33.8%) had low HL and 174 (64.0%) had adequate HL. Compared to patients with adequate HL, patients with low HL reported lower rates of a health care provider in the surgeon’s clinic definitely giving them all the information needed about their surgery (80.9% versus 90.1%, p=0.07) and lower rates of their surgeon or other provider definitely talking to them about what to expect for surgery and recovery (76.4% versus 89.0%, p=0.03, respectively). Low and adequate HL patients reported similar rates of receiving instructions about getting ready for surgery (88.6% and 90.1%, p=0.66). However, 88.3% of low HL patients reported these instructions were easy to understand compared to 97.4% for adequate HL patients (p=0.001). Low and adequate HL patients reported similar rates of visual aids used during education (76.1% versus 78.2%, p=0.54, respectively), with low HL patients reporting slightly lower use of flyers/pamphlets with pictures (58.7% versus 60.3%, p=0.79) and drawings (40.2% versus 42.5%, p=0.72); similar use of models (9.8% versus 9.2%, p=0.86); and less frequent use of videos (7.6% versus 10.9%, p=0.39). Conclusions: Patient-reported disparities in preoperative education exist among surgical cancer patients with low health literacy. 1 in 5 patients with low HL did not think they received enough information prior to surgery and the information they received was difficult to understand. Overall, there was a low use of visual aids among this patient population. Future directions should aim to improve the quality of education for low HL, incorporating the use of visual aids.