Expert consensus on precision surgery for gastric cancer conversion therapy (2025 edition)

Gastric cancer ranks among the most prevalent and lethal malignancies in China, with approximately 30%‒40% of patients diagnosed at stage Ⅳ. Although systemic therapy has modestly improved survival in some cases, the overall prognosis remains poor. In recent years, advancements in precision surgical concepts and oncology research have introduced novel individualized treatment strategies centered on immunotherapy, precision molecular subtyping, and multi-omics testing, offering new opportunities for managing stage Ⅳ gastric cancer. However, there is currently no established consensus in China on the standardized implementation of conversion therapy for stage Ⅳ disease. To address this gap, the Chinese Expert Consensus on Precision Surgery for Gastric Cancer Conversion Therapy (2025 Edition) is developed through multidisciplinary collaboration among experts in gastrointestinal surgery, medical oncology, radiology, and pathology. This consensus systemati-cally reviews the latest clinical evidence on conversion therapy, incorporates insights into critical challenges in Chinese clinical practice, and refines key aspects including patient stratification, molecular-guided precision therapy, prediction of conversion success, surgical planning, and perioperative management. The document aims to standardize clinical practices for stage Ⅳ gastric cancer conversion therapy and provide clinicians with scientifically robust and practical decision-making guidance.