Essential Updates 2023/2024: Recent Advances of Multimodal Approach in Patients for Gastric Cancer

Gastric cancer remains a major global health burden, especially in East Asia. Recent years have brought significant advances in multimodal management, including surgery, perioperative chemotherapy, immunotherapy, and supportive care. This review summarizes key updates from 2023 to 2024, focusing on surgical innovations, perioperative systemic therapy, treatment strategies for stage IV disease, and nutritional interventions. In early and locally advanced disease, laparoscopic and robotic gastrectomy have become widely accepted in Asia, supported by large, randomized trials such as JCOG0912 and KLASS-02. Perioperative chemotherapy has become a global standard, with the FLOT regimen leading in the West and SOX, XELOX, or DOS emerging in Asia. Immunotherapy is increasingly incorporated into perioperative settings, with trials like KEYNOTE-585 and NEONIPIGA suggesting potential benefit in selected patients. For stage IV gastric cancer, systemic chemotherapy remains the mainstay, but conversion surgery and treatment of oligometastasis have shown promising results in selected cases. Trials such as JCOG1704 and AIO-FLOT5 are investigating optimal strategies. Perioperative nutrition has also gained attention, with oral nutritional supplements, ERAS protocols, and digital tools like continuous glucose monitoring (CGM) and AI-driven platforms enhancing outcomes. Looking ahead, integration of molecular biomarkers (e.g., HER2, PD-L1, MSI, ctDNA), precise staging, and multidisciplinary collaboration will be essential for personalized treatment. Ongoing trials and international cooperation are expected to further refine evidence-based approaches to gastric cancer care.