Neoadjuvant therapy has become a key component of perioperative management for locally advanced gastric cancer. By inducing tumor downstaging and downgrading, it increases the likelihood of R0 resection, facilitates early control of micrometastatic disease, and informs subsequent adjuvant treatment strategies. However, treatment-induced changes, including tissue edema, adhesions, fibrosis, and disruption of anatomical planes, increase the technical complexity of laparoscopic radical gastrectomy and pose greater challenges to lymph node dissection, margin assessment, gastrointestinal reconstruction, and perioperative management. In the era of neoadjuvant therapy, the goal of gastric cancer surgery has evolved from achieving radical resection alone to balancing oncological efficacy with surgical safety. Standardized laparoscopic techniques, optimized perioperative care, and multidisciplinary management are essential to improve surgical quality and reduce perioperative risks. Future efforts should focus on refining patient selection, optimizing preoperative evaluation and surgical decision-making, and advancing perioperative strategies, thereby promoting a more precise and individualized approach to minimally invasive surgery for gastric cancer.