The incidence and mortality rates of gastric cancer are among the top three cancers in China, which poses great threat to people's lives and health. So far, surgery remains to be the cornerstone of treatment for gastric cancer. With the development of laparoscopic surgery, minimally invasive treatment techniques, together with the deepening of clinical researches, as we review the research progress in 2021, the core controversial issues of gastric cancer surgery have been basically addressed. The series of "minimal-innovation" concepts and technologies represented by single-incision/reduced-port laparoscopic surgeries have been further developed; radiomics and artificial intelligence aided prediction have been applied into the forefront of surgical accurate decision-making; targeted and immune-therapy is about to break through the bottleneck of surgical efficacy of gastric cancer. Currently, molecular imaging and targeted tracer guided precision cancer surgery are being explored, which is expected to revolutionize in key links such as real-time in-vivo determination of tumor margin, tracing of metastatic lymph nodes and visualization of nerves. Looking forward into the future, gastric cancer surgery will break through the century-old ceiling of "gross appearance by naked eye" and "traditional extensive experience", and set off a new round of technological revolutions in molecular visualization intelligent precision minimally invasive surgery.
胃癌是我国肿瘤发病率和死亡率均高居全国前3位的恶性疾病，严重威胁人民群众生命健康。迄今，外科手术仍是治疗的基石。随着腹腔镜微创技术的发展及其临床研究的深入，回顾2021年研究进展，胃癌外科的核心争议问题已基本解决，以单孔/减孔为代表的系列"微创新"理念与技术进一步发展，影像组学和人工智能辅助预测已深入到外科精准决策前沿，靶向和免疫转化治疗即将突破胃癌外科疗效瓶颈。当前，正在探索中的分子影像与靶向示踪引导下的精准肿瘤外科手术，有望在肿瘤边界实时在体判定、转移淋巴结示踪及可视化神经等关键环节取得突破。展望未来，胃癌外科一定能够突破"大体肉眼外观"、"传统粗放经验"的百年天花板，掀起分子可视化智能精准微创外科新一轮技术革命。.
Keywords: Gastric cancer; Minimally invasive techniques; Molecular imaging; Surgical procedures; Targeted tracing.