Pathological and molecular testing of gastric cancer is a prerequiste for precise treatment. Routine testing for human epidermal growth factor receptor 2 (HER2), microstatellite instability/mismach repair, programmed cell death ligand 1 combined positive score, Claudin18.2 are recommended. Locally advanced gastric cancer progress to metastasis or positive free cancer cells in abdoimnal cavity is greater than 20%, laparoscopic exploration and staging is recommended before neoadjuvant therapy. Positive free cancer cells in the peritoneal cavity are one of the main forms of peritoneal metastasis in gastric cancer. Rapid frozen section examination of peritoneal lavage fluid can significantly increase the positive rate. Accurate ex vivo dissection of lymph nodes after D2 radical gastrectomy is an important meansure to ensure surgical quality, precisely evaluate prognosis, and formulate individualized adjuvant therapy regimens. Perioperative SOX chemotherapy for locally advanced gastric cancer has become a Chinese paradigm, and perioperative immunotherapy has emerged as a new standard. Preliminary results have also been achieved in the exploration of neoadjuvant target-immuno-chemotherapy for HER2 positive locally advanced gastric cancer, as well as neoadjuvant therapy with bispecific antibody (AK104) combined with SOX for HER2 negative gastric cancer. For advanced gastric cancer with peritoneal metastasis, paclitaxel dual-path chemotherapy can improve the R0 resection conversion rate and long-term survival of patients. For patients with potentially resectable gastric cancer with liver metastasis, active comprehensive treatment based on multidisciplinary team model an significantly imporve the R0 resection conversion rate. Target-immuno-chemotherapy for conversion therapy in stage Ⅳ gastric cancer can significantly improve the pathological complete response rate and long-term survival of patients after conversion surgery.