As a preeminent anticancer natural product, (+)-pancratistatin has always been a privileged synthetic target. Herein, the total synthesis of (+)-pancratistatin is reported in 10 linear steps by utilizing a known aldehyde as chiral source. This synthetic route features a highly stereoselective intermolecular Michael addition and intramolecular Henry reaction to construct a cyclohexane ring bearing 6 successive stereocenters. Moreover, all of the synthetic steps are reliable and efficient and can be easily scaled up, which facilitated anticancer pharmacological tests of (+)-pancratistatin. Importantly, a new pharmacological mechanism of action was discovered for the first time where (+)-pancratistatin is able to inhibit the activity of topoisomerase I, which would pave the way for the development of new-type Topo I inhibitors.