The study included more esophageal and combined gastroesophageal cancers, and the proportion of standard D2 radical surgery performed in Europe is not high and should not be followed blindly. In Japan and Korea, there are not many people who really accept NAC and it is still in the research stage. Prof. Gomes from Brazil pointed out that the incidence of gastroesophageal cancer in Brazil is high and the diagnosis is mostly advanced, so NAC studies have not been carried out in depth. Therefore, NAC for gastric cancer can be used in some locally progressive gastric cancers, but single agent application is not recommended and the specific strategy deserves to be studied. From an internal medicine perspective, there are four aspects that confirm the value of NAC: improving the radical resection rate through tumor downstaging, eliminating micro-metastases, providing information for postoperative adjuvant therapy as an in vivo drug sensitivity test, and better tolerated by patients than postoperative chemotherapy. The European MAGIC study demonstrated a significant benefit for those treated with the CSC modality, with a 13% increase in 5-year survival and a 4-month extension in median survival. The study also suggested that patients with stage IIIB and IV (M0) had higher R0 resection rates after neoadjuvant therapy. The domestic RESOLVE study was conducted for locally progressive gastric cancer with CSC model compared with SC model, aiming to further validate the value of NAC. After neoadjuvant treatment, some patients with tumor shrinkage could receive surgical resection. Then, how should the results of in vivo drug sensitivity test be judged? The EORTC-40954 study used endoscopy combined with CT to determine the efficacy and classified the efficacy into CR, PR and PD, which provides a new idea to evaluate the efficacy of chemotherapy in cavity organs. From a surgical perspective, NAC has two concerns-indications for application and criteria for efficacy assessment. The indications for NAC vary from country to country: ≥T2N+ in the United States; locally progressive, T3-4 and N+ in China; and high risk of recurrence, cIIIA-IIIC, and Bowman type III/IV in Japan. The differences between East and West focused on the different management of T2N+. Regarding the efficacy of NAC, the results of several randomized controlled studies are now expected to provide more evidence. In terms of safety, chemotherapy-induced vascular inflammation and edema increase the risk of postoperative complications, and the balance between safety and efficacy must be accurately determined.