[Precise prevention and treatment strategies for surgical complications after conversion therapy for gastric cancer]

Conversion therapy offers a potential curative opportunity for patients with initially unresectable gastric cancer. However, the consequent systemic and local pathophysiological changes significantly increase the risk of perioperative complications, posing challenges to traditional surgical management and enhanced recovery after surgery (ERAS) pathways. Based on the latest evidence and our center's experience, this article systematically elaborates on the multifaceted impacts of conversion therapies (chemotherapy, immunotherapy, targeted therapy, and radiotherapy) on patients' cardiopulmonary function, nutritional metabolism, intestinal barrier function, and tissue anatomy (edema, fibrosis). Addressing these alterations, we delve into the technical challenges encountered during surgery, including difficulties in identifying anatomical planes, increased risk of collateral damage, and compromised quality of lymph node dissection. Corresponding strategies are proposed, encompassing precise preoperative planning, optimized surgical approaches, and graded bleeding control. Regarding postoperative management, we focus on the prevention and treatment of infections, anastomotic leakage, bleeding, and gastrointestinal dysfunction, emphasizing the need to monitor for delayed immune-related adverse events. Building upon this, we propose and construct a comprehensive management system integrating preoperative prehabilitation, precision surgical techniques, individualized anesthesia, and postoperative ERAS pathways, emphasizing a holistic approach based on "point-to-point" stress regulation and biological barrier protection. Finally, we explore future directions, including individualized treatment guided by molecular subtyping and the development of intelligent whole-process management systems, aiming to provide a systematic reference for clinical diagnosis and treatment strategies.