In clinical work, I am often asked by patients, “Can I do a minimally invasive procedure in this case?” “Is opening the stomach a cleaner cut?” “Does minimally invasive mean endoscopic removal?” As a doctor, you often mistakenly think that such questions are “common knowledge”, why do patients ask them repeatedly? In fact, this is due to the information asymmetry between doctors and patients, and it takes time for anyone to learn this kind of medical knowledge, so from the doctor’s point of view, they should be more understanding to patients and families, and try to explain patiently to give them time to understand and digest. So, let’s briefly understand the basic knowledge of minimally invasive treatment for gastric cancer today. (1) What is minimally invasive treatment for gastric cancer? Minimally invasive treatment for gastric cancer usually refers to laparoscopic radical gastric cancer treatment. The free stomach and surrounding lymph node dissection are completed under laparoscopy, and the reconstruction of the digestive tract is completed through an adjuvant incision or continued under laparoscopy. Compared with the “huge” incision of 25 cm long in traditional open radical gastric cancer surgery, laparoscopic minimally invasive surgery can significantly reduce abdominal wall damage and evaporation of body fluids caused by exposure of organs to air during surgery. At the same time, the magnification of the laparoscope makes the operation more delicate, with clearer and more accurate judgment of the anatomical levels, less intraoperative side injuries, and less intraoperative bleeding, which facilitates rapid postoperative recovery. However, laparoscopic minimally invasive surgery also has some disadvantages, such as prolonged operation time and pneumoperitoneum-related complications. For some cases with large tumors, invasion of surrounding organs, and obvious enlargement and fusion of surrounding lymph nodes, the application of laparoscopic surgery is greatly limited. The example often given to patients is the so-called open surgery and minimally invasive surgery for the treatment of gastric cancer, which is roughly equivalent to whether to eat with hands or chopsticks, the purpose is to eat (cure), only the pathway is different. Most of the current clinical research findings agree that the safety and long-term efficacy of open and laparoscopic surgery are comparable in the treatment of gastric cancer, while laparoscopic surgery has faster recovery. Overall, laparoscopic minimally invasive surgery is the direction and trend of future development. (2) Can minimally invasive treatment for gastric cancer be “clean”? ”If you open your stomach during surgery, you can see everything clearly, can’t it be cut more cleanly? “This is the common understanding of some patients and their families. In fact, whether it is open or minimally invasive surgery, the scope of stomach removal and lymph node dissection are the same. The extent of lymph node clearance is not based on what is seen by the naked eye as a standard for resection, but rather on the grouping of lymph nodes, revealing the required anatomical site as a sign of completion of clearance. In addition, due to the magnification of the laparoscope, it is somehow better to detect smaller enlarged lymph nodes instead. The idea that the larger the opening, the clearer the view and the more thorough the cut is, is a bit too much to be taken for granted. In short, minimally invasive can cut “cleanly”, just as “cleanly” as open laparoscopy, or even more “cleanly”. (3) Is minimally invasive treatment of gastric cancer endoscopic resection? Minimally invasive treatment for gastric cancer is not endoscopic resection. Endoscopic resection of gastric cancer is limited to early gastric cancer with good differentiation type, small area and confined to the mucosal layer or submucosal layer. The indications are discussed in detail in the Japanese Statute for the Management of Gastric Cancer, the Japanese Guidelines for Gastric Cancer, and the Chinese Consensus Opinion on Screening and Endoscopic Diagnosis and Treatment of Early Gastric Cancer. (4) Is minimally invasive treatment possible for all gastric cancers? There are still controversies about the indications for laparoscopic radical gastric cancer surgery. According to the Japanese Guidelines for Gastric Cancer, laparoscopic radical gastric cancer surgery has become the current routine treatment in gastric cancer with early stage (clinical stage I). However, for progressive gastric cancer, the application of laparoscopic radical gastric cancer surgery is still limited to some extent. In recent years, laparoscopic gastric cancer surgery has been flourishing in China, and some primary hospitals are also equipped with the conditions to perform such surgery. According to the Domestic Guidelines for the Operation of Laparoscopic Gastric Cancer Surgery (2016 edition), the indications for surgery have been expanded to clinical stages I, II, and IIIa. In conclusion, as mentioned before, laparoscopic radical gastric cancer surgery should be carefully selected for some cases with large tumors, invasion of surrounding organs, and obvious enlargement and fusion of surrounding lymph nodes. And this choice should be based on the current treatment standard guidelines and the clinical experience of the surgeon, so as to find out the most favorable approach for the patient.