76 A new set of clinical guidelines for gastric cancer has been released, bringing updated recommendations that could change the way the disease is diagnosed and treated. Developed by the Korean Gastric Cancer Association and supported by the National Cancer Center, the guidelines reflect the latest research and provide evidence-based strategies for managing the condition. The findings were published in the Journal of Gastric Cancer. The 2024 guidelines introduce significant updates on systemic treatments, surgical approaches, and targeted therapies. One of the key recommendations is the continued use of immunotherapy in combination with chemotherapy for patients with unresectable or metastatic gastric cancer. This approach has shown promise in improving survival rates, although some studies indicate that its effectiveness varies depending on individual patient factors. Experts believe that further clinical trials will be needed to refine treatment selection criteria. Another notable change focuses on conversion surgery, which involves surgical resection following systemic therapy for patients with metastatic gastric cancer. The latest evidence suggests that this strategy could offer improved outcomes for carefully selected patients, particularly those who achieve a strong response to chemotherapy. However, researchers caution that more large-scale trials are required to confirm its long-term benefits. Surgical recommendations have also been refined, with an emphasis on personalised treatment approaches. The updated guidance acknowledges that laparoscopic surgery may be an option for some patients, provided they are treated by highly experienced surgeons. While open surgery remains the standard approach, laparoscopic techniques are gaining acceptance due to their potential for reduced recovery times and fewer complications. The guidelines also address the ongoing debate over the extent of lymph node dissection during surgery. For patients undergoing conversion surgery, a minimum of six months of systemic therapy is recommended to maximise the chances of achieving complete resection. Additionally, the new recommendations highlight the need for careful assessment of liver and para-aortic lymph node metastases, even when imaging suggests a complete response to therapy. Another area of focus in the revised guidelines is the treatment of oligometastatic disease, which refers to cancer that has spread to only a limited number of sites. The evidence supporting surgical intervention for these patients remains limited, but some retrospective studies suggest that metastasectomy could offer survival benefits in select cases. However, the overall quality of data remains low, and experts stress the importance of individualised decision-making. The role of neoadjuvant chemotherapy has been reaffirmed as a valuable approach for locally advanced gastric cancer. The guidelines recommend its use as part of perioperative treatment, suggesting that it can improve survival compared to surgery alone. However, the effectiveness of adjuvant chemotherapy remains uncertain for certain subgroups, particularly patients with microsatellite instability-high tumours. More research is needed to determine the best course of treatment for these individuals. The updated guidelines emphasise the importance of a multidisciplinary approach to gastric cancer management. Surgeons, oncologists, radiologists, and pathologists are encouraged to work closely together to develop personalised treatment plans. Regular updates to the guidelines will continue to reflect emerging evidence, ensuring that patients receive the most effective care based on the latest scientific findings.