Liver metastasis is one of the most common causes of death in patients with advanced gastric cancer. The role of hepatic resection for colorectal cancer liver metastases has been widely accepted, but the significance of hepatic resection for gastric cancer liver metastases is still controversial. What treatment should be chosen for patients with gastric cancer liver metastases? The following discussion is based on two cases of liver metastasis from gastric cancer. Case 1, an elderly male with gastric cancer with multiple liver metastases (3 metastases), was treated with 6 cycles of paclitaxel + fluorouracil + cisplatin chemotherapy with obvious efficacy, and only 1 liver lesion remained, and the patient refused to receive follow-up chemotherapy. Therefore, simultaneous radical resection of gastric cancer and liver metastases was performed. New liver metastases appeared in the hepatogastric space 6 months after surgery, and local hepatic artery embolization chemotherapy was performed. From the diagnosis of gastric cancer with neoadjuvant chemotherapy to simultaneous radical surgery for gastric cancer and liver metastases, and postoperative liver metastases again to interventional therapy, the patient obtained an overall survival of 18 months. Her condition is currently stable. Case 2, a young female with gastric cancer with multiple liver metastases, did not show significant remission after 8 cycles of chemotherapy with Tysodi + fluorouracil + cisplatin. The patient actively requested surgery, so palliative surgery for liver metastases was performed. 6 weeks after surgery, systemic multiple metastases appeared and the disease progressed. Liver is the main target organ for hematogenous metastasis of gastric and colorectal cancer, but due to the different biological characteristics and anatomical features of gastric cancer and intestinal cancer, the treatment options for liver metastasis occurring between them are completely different. Colorectal cancer flows back into the liver through the portal system, and sometimes the liver may be the only site of colorectal cancer metastasis, so resection of liver metastases may achieve the purpose of cure, and its resection rate is 20~50%, and the 5-year survival rate is 30~50%. Gastric cancer is prone to peritoneal metastasis, followed by liver metastasis. When liver metastasis occurs in gastric cancer, it is mostly accompanied by peritoneal metastasis, lymph node metastasis, and even invasion of adjacent organs. Only the rare isolated liver metastases of gastric cancer, which do not involve the plasma membrane of the primary cancer or lymph node metastases, have a better postoperative prognosis. Only 10-20% of patients with liver metastases from gastric cancer are suitable for hepatectomy, and the 5-year survival rate is 0-30%. Therefore, the status of liver metastasis of gastric cancer is much less than that of liver metastasis of intestinal cancer. For case 1 it makes sense to choose surgery with effective neoadjuvant chemotherapy and achieve radical cure. However, for case 2 palliative surgery for liver metastases only proved to be meaningless for improving survival and outcome. Carefully selected simultaneous resection of gastric and hepatic metastases has the potential to improve patient prognosis, but attention should be paid to the selection of indications. Radical surgery can be considered for patients with single liver metastases or those limited to one lobe of the liver or those with involvement of the left or right liver, but the number of nodes does not exceed three, the amount of hepatic resection does not exceed 5 0 %, there are no extrahepatic metastases, and their general condition can tolerate hepatic resection. Superficial infiltration of primary foci, few lymphatic metastases, heterochronic liver metastases, single metastases and well-differentiated histological types of pseudo-envelope formation and metastatic nodes are favorable factors affecting the prognosis of patients with gastric cancer, and factors associated with primary gastric cancer are not important determinants of prognosis. However, those patients with diffuse liver metastases should be very cautious even to perform palliative gastrectomy for gastric cancer. Although some scholars believe that palliative gastrectomy can prolong the survival of patients with advanced gastric cancer when peritoneal dissemination, liver metastases, and distant lymph node metastases are not curable. However, more studies do not advocate palliative gastrectomy for patients with peritoneal spread without obstruction. In addition, in case 1, after effective chemotherapy for relief of liver metastases from gastric cancer, the original effective drug can also be selected for monotherapy maintenance treatment. A recent study published in JCO on the surgical treatment of liver metastases from gastric cancer, including simultaneous and heterochronic resection of liver metastases from gastric cancer, showed a prolonged DFS but no change in OS for R0 compared with R1 resection (no difference in overall survival between the two, probably due to more aggressive follow-up treatment for R1 resection). Unlike liver metastases from gastric cancer, liver metastases from colorectal cancer still have a better prognosis than those without R1 resection. Moreover, the number of metastases is not an independent factor in the prognosis of liver metastases from colorectal cancer as long as they can be completely resected. The currently accepted mechanism of liver metastasis from gastric cancer is metastasis through the hematogenous route. However, some studies have suggested that liver metastasis of gastric cancer may be through the lymphatic route, and animal models have been used to confirm that lymphatic and venous traffic branches can be generated when lymphatic vessels are obstructed, suggesting the possibility that liver metastasis of gastric cancer is metastasis through the lymphatic route. Therefore, it is considered that extra-lymph node invasion is an important risk factor for gastric cancer, especially liver metastasis of gastric cancer. For patients with liver metastases from gastric cancer with abdominal lymph nodes and metastases from other sites, deliberately expanding the resection area of the involved organs and lymph node metastases during surgery does not improve the survival rate. Local treatments, such as radiofrequency ablation therapy, hepatic artery perfusion and hepatic artery embolization chemotherapy, can also be chosen at this time. Although these treatments have not been documented to prolong overall survival of patients, they have a role in improving symptoms. Numerous studies have shown that the prognosis of resection of liver metastases from either concurrent or heterochronic gastric cancer is worse than that of liver metastases from intestinal cancer, suggesting that the prognosis of liver metastases from gastric cancer may be improved by effective adjuvant and neoadjuvant chemotherapy. However, due to the low incidence of gastric cancer in Europe and the United States, insufficient investment in gastric cancer research has led to much less rapid progress in the treatment of gastric cancer than intestinal cancer. So far the only regimen recommended by NCCN guidelines for neoadjuvant and adjuvant therapy is the ECF regimen, and there is no consensus on treatment regimens that include new drugs such as paclitaxel, oxaliplatin and irinotecan . With the continuous progress of chemotherapy and targeted drugs, there are more and more protocols for the treatment of advanced gastric cancer, and these protocols for neoadjuvant and adjuvant chemotherapy of gastric cancer will help to improve the possibility of obtaining radical treatment of gastric cancer liver metastases through surgery. Therefore, with the gradual development of clinical research on the new generation of chemotherapy protocols for neoadjuvant and adjuvant chemotherapy (including targeted drugs) of advanced gastric cancer, surgical treatment in gastric cancer liver metastasis will also continue to increase in status. After radical surgery for gastric cancer, the selection of appropriate adjuvant chemotherapy is of great importance for the prevention of liver metastasis.