What is the level of preoperative radiotherapy before surgical resection for upper gastric cancer? Patients undergoing preoperative radiotherapy need to undergo about five weeks of radiotherapy combined with some chemotherapy in between, and surgery can be performed about six weeks after the end of preoperative radiotherapy and chemotherapy. Patients who enter a clinical study usually get the best treatment or the best outcome. The design of a clinical study protocol must be based on the evidence available at home and abroad, and the feasibility and safety of the protocol must be confirmed through relevant preliminary work before it can be approved by the ethics committee. Are there any adverse reactions to preoperative radiotherapy? In fact, the adverse effects of radiotherapy are not that frightening, and the proportion of severe adverse effects in radiotherapy studies available at home and abroad does not exceed 5%, which is a very low proportion. In general, the vast majority of patients can tolerate preoperative radiotherapy. Is there any difference in the extent of resection in patients who have undergone preoperative radiotherapy and then undergo surgical resection? Is total gastrectomy still required? The standard treatment for upper gastric cancer is total gastrectomy + second lymph node dissection. Patients who have undergone preoperative radiotherapy also need total gastrectomy and second lymph node dissection during surgery, which is the same as the standard surgery. After preoperative radiotherapy and abdominal metastasis, is surgical resection still necessary? Most of the patients have to undergo laparoscopic examination for tumor staging. Most of the patients have good results with preoperative chemotherapy, and the possibility of abdominal metastasis after preoperative radiotherapy is very small. In case of such a situation, the tumor is stage IV. Usually, surgery is not necessary for patients with stage IV tumor.