Modern Treatment Strategies for Resectable Gastric Cancer: A Scoping Review

Gastric cancer remains a leading cause of cancer death worldwide, and management of resectable disease has evolved considerably in recent years. This scoping review synthesizes evidence from major clinical trials, meta-analyses, and guidelines that inform the current treatment landscape for resectable gastric cancer. Over the past two decades, management has shifted from surgery alone toward multimodal strategies, incorporating perioperative chemotherapy, chemoradiation, immunotherapy, and targeted therapies. Perioperative chemotherapy with FLOT is now the Western standard, and minimally invasive approaches have demonstrated oncologic equivalence to open surgery. Most recently, the integration of immune checkpoint inhibitors into the perioperative setting for biomarker-selected populations represents a major evolution in treatment. Meanwhile, the role of anti-HER2 therapy in resectable disease remains undefined, and the management of peritoneal disease through cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy continues to evolve. Key areas going forward include biomarker-driven treatment selection, organ preservation after complete clinical response, and extension of immunotherapy and targeted therapy benefits to microsatellite stable disease. This review traces the rapid evolution toward more tailored treatment and highlights where ongoing trials may change practice.